Basic Information
| Provider Information | |||||||||
| NPI: | 1023476272 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | KARLA | ||||||||
| MiddleName: | JOANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | AGACNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 85 E US 6 FRONTAGE RD | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 46383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199838300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2000 ROOSEVELT RD BLDG A | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463832800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2192637240 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2016 | ||||||||
| LastUpdateDate: | 10/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 71007069A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.