MEDICARE: NICOLE MARIE HANSARD

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
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1558126896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE HANSARD

Provider Business Mailing Address
First Line	:	870 MOUNT VERNON AVE STE 300
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1410
Country	:	US
Telephone Number	:	614-629-4698
Fax Number	:

Provider Business Practice Location Address
First Line	:	2173 W MOUND ST APT C
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-2042
Country	:	US
Telephone Number	:	614-290-0052
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2024
Last Update Date	:	02/15/2024

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Directions to “ NICOLE MARIE HANSARD ” Practice Location

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