Provider Demographics
NPI:1366763807
Name:HANSON, JILL R (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:R
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:R
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6031 E WOODMEN RD STE 300
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2624
Mailing Address - Country:US
Mailing Address - Phone:719-867-7814
Mailing Address - Fax:
Practice Address - Street 1:6031 E WOODMEN RD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2624
Practice Address - Country:US
Practice Address - Phone:719-867-7800
Practice Address - Fax:719-867-7899
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0067275207K00000X, 207K00000X
MO2011036407208000000X
NE29011207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics