Provider Demographics
NPI:1023251915
Name:HANSON, TONIA C (PA-C)
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:C
Last Name:HANSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 SILVER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-1658
Mailing Address - Country:US
Mailing Address - Phone:847-462-3120
Mailing Address - Fax:847-669-7590
Practice Address - Street 1:1425 N RANDALL RD
Practice Address - Street 2:SUITE 404
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:224-783-8129
Practice Address - Fax:224-783-2852
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003573363A00000X
CAPA20299363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085003573OtherSTATE LICENSE