Healthcare Provider Details

I. General information

NPI: 1366763807
Provider Name (Legal Business Name): JILL R HANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL R RUSSELL

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6031 E WOODMEN RD STE 300
COLORADO SPRINGS CO
80923-2624
US

IV. Provider business mailing address

6031 E WOODMEN RD STE 300
COLORADO SPRINGS CO
80923-2624
US

V. Phone/Fax

Practice location:
  • Phone: 719-867-7800
  • Fax: 719-867-7899
Mailing address:
  • Phone: 719-867-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberDR.0067275
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: