Healthcare Provider Details

I. General information

NPI: 1831390012
Provider Name (Legal Business Name): CAROL ELIZABETH HANSEN RNC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 01/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 CONGRESS ST
SPRINGFIELD MA
01104-3564
US

IV. Provider business mailing address

12 WAGON DR
WILBRAHAM MA
01095-1678
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-0040
  • Fax: 413-732-7007
Mailing address:
  • Phone: 413-599-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number126357
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: