Healthcare Provider Details

I. General information

NPI: 1396790515
Provider Name (Legal Business Name): SUSAN C. HANSEN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5126 HOSPITAL DR NE
COVINGTON GA
30014-2566
US

IV. Provider business mailing address

PO BOX 235022
MONTGOMERY AL
36123-5022
US

V. Phone/Fax

Practice location:
  • Phone: 334-386-2053
  • Fax: 334-244-1830
Mailing address:
  • Phone: 334-386-2053
  • Fax: 334-244-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberRN143516
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: