Healthcare Provider Details

I. General information

NPI: 1144256165
Provider Name (Legal Business Name): MS. MARY FRANCES HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD PRE-PROCEDURE CLINIC 112-B
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

4223 N LONGVIEW AVE
PHOENIX AZ
85014-4526
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax: 602-200-6033
Mailing address:
  • Phone: 602-274-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: