Healthcare Provider Details

I. General information

NPI: 1659153732
Provider Name (Legal Business Name): MRS. TESS HANEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 04/12/2025
Certification Date: 04/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6975 W GLENDALE AVE
GLENDALE AZ
85303-2611
US

IV. Provider business mailing address

3003 N CENTRAL AVE STE 1600
PHOENIX AZ
85012-2908
US

V. Phone/Fax

Practice location:
  • Phone: 623-323-3344
  • Fax: 602-323-3496
Mailing address:
  • Phone: 602-323-3344
  • Fax: 602-323-3496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number300210
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number300210
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN127977
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: