Healthcare Provider Details

I. General information

NPI: 1932758604
Provider Name (Legal Business Name): JENNIFER HANSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BOURGADE ST STE 2
LENEXA KS
66219-1440
US

IV. Provider business mailing address

8700 BOURGADE ST STE 2
LENEXA KS
66219-1440
US

V. Phone/Fax

Practice location:
  • Phone: 913-676-8400
  • Fax:
Mailing address:
  • Phone: 913-676-8400
  • Fax: 913-599-1692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-78958-041
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: