Healthcare Provider Details

I. General information

NPI: 1528121548
Provider Name (Legal Business Name): CAROL ANN HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 OLD RANCH RD
HAMILTON MT
59840-8944
US

IV. Provider business mailing address

2009 OLD RANCH RD
HAMILTON MT
59840-8944
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-2526
  • Fax:
Mailing address:
  • Phone: 406-363-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN15353
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: