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NPI Code Detail

MEDICARE: CALEB R HANSEN

MEDICARE: CALEB R HANSEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1063356251
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALEB R HANSEN
Provider Business Mailing Address
First Line : PO BOX 423
Second Line :
City : ALAMO
State : NV
Zip : 89001-0423
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 620 SHADOW LN
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4194
Country : US
Telephone Number : 702-388-8436
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/17/2026
Last Update Date : 06/23/2026

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Directions to “ CALEB R HANSEN ” Practice Location

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