Provider Demographics
NPI:1689467037
Name:HANSEN, ERIK WARREN (FNP-BC)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:WARREN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 EXECUTIVE PKWY STE M4
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5291
Mailing Address - Country:US
Mailing Address - Phone:847-305-1954
Mailing Address - Fax:
Practice Address - Street 1:345 EXECUTIVE PKWY STE M4
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5291
Practice Address - Country:US
Practice Address - Phone:847-305-1954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2024057378363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily