Healthcare Provider Details

I. General information

NPI: 1437299831
Provider Name (Legal Business Name): MARY PAT HANSEN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY PATRICIA COSGROVE CPNP

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 W MAIN ST SOUTH VALLEY PEDIATRICS
HAMILTON MT
59840
US

IV. Provider business mailing address

1114 W MAIN ST SOUTH VALLEY PEDIATRICS
HAMILTON MT
59840
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-5013
  • Fax: 406-363-3714
Mailing address:
  • Phone: 406-363-5013
  • Fax: 406-363-3714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN 31255
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: