Healthcare Provider Details

I. General information

NPI: 1205994951
Provider Name (Legal Business Name): BRENDA G HANSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 BLAKE AVENUE SUITE 208
GLENWOOD SPRINGS CO
81601-4261
US

IV. Provider business mailing address

1906 BLAKE AVE ATTN GABRIELA RAND- MEDICAL STAFF OFFICE
GLENWOOD SPRINGS CO
81601-4227
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-2238
  • Fax: 970-928-8926
Mailing address:
  • Phone: 970-384-7033
  • Fax: 970-384-8173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number116964
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM4129
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPN.0996102-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: