Active NPI
Jonathon William Hansen, RN
- Registered Nurse
- Mellen, WI
National Provider Identifier
1982220265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 2423148
- Practice address
- 450 Lake Dr
Mellen, WI 54546-9750 - Phone
- (715) 274-5706
- Fax
- (715) 274-2702
- NPI assigned
- Jun 22, 2020
- Last updated
- Jun 22, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2423148 | MN | Primary |
Addresses
Primary practice location
450 Lake Dr
Mellen, WI 54546-9750
Mailing address
7060 1St St NE
Sauk Rapids, MN 56379-9693
Phone (320) 828-7310
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2423148 | MN | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shell Lake SNF LLC | Current | Accepting new patients | |
| Mellen Manor LLC | Current | Accepting new patients |
Locations
450 Lake Dr
Mellen, WI 54546
Phone (715) 274-5706
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Shell Lake Health Care Center
- Nursing Facility/Intermediate Care Facility
- Shell Lake, WI
- NPI 1295939049
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592784000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592784000000",
"number": "1982220265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7060 1ST ST NE",
"city": "SAUK RAPIDS",
"state": "MN",
"postal_code": "563799693",
"telephone_number": "320-828-7310",
"fax_number": "715-274-2702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "450 LAKE DR",
"city": "MELLEN",
"state": "WI",
"postal_code": "545469750",
"telephone_number": "715-274-5706",
"fax_number": "715-274-2702"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HANSEN",
"first_name": "JONATHON",
"middle_name": "WILLIAM",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-06-22",
"last_updated": "2020-06-22",
"certification_date": "2020-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "2423148",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mellen, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.