Healthcare Provider Details

I. General information

NPI: 1518904119
Provider Name (Legal Business Name): DENISE MIRA HANSEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

997 OLD US HWY 70 W STE A
BLACK MOUNTAIN NC
28711-4505
US

IV. Provider business mailing address

997 OLD US HWY 70 W STE A
BLACK MOUNTAIN NC
28711-4505
US

V. Phone/Fax

Practice location:
  • Phone: 828-698-7981
  • Fax: 828-298-6010
Mailing address:
  • Phone: 828-298-7981
  • Fax: 828-698-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201689
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: