Healthcare Provider Details

I. General information

NPI: 1386085629
Provider Name (Legal Business Name): ABRAHAM C. HANSON ACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HARRY S TRUMAN DR N
UPPER MARLBORO MD
20774-5477
US

IV. Provider business mailing address

550 1ST AVE
NEW YORK NY
10016-6402
US

V. Phone/Fax

Practice location:
  • Phone: 240-677-3000
  • Fax:
Mailing address:
  • Phone: 212-263-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number17192
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209011165
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number430878
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR253541
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: