Basic Information
Provider Information
NPI: 1154781342
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HANSMANN
FirstName: ASHLEY
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 400 E 10TH ST
Address2:  
City: WACONIA
State: MN
PostalCode: 553874552
CountryCode: US
TelephoneNumber: 9524429770
FaxNumber: 9524423620
Practice Location
Address1: 4050 COON RAPIDS BLVD NW
Address2:  
City: COON RAPIDS
State: MN
PostalCode: 554332522
CountryCode: US
TelephoneNumber: 8882090305
FaxNumber: 9524423620
Other Information
ProviderEnumerationDate: 03/01/2016
LastUpdateDate: 04/25/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000XR 212963-3MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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