Healthcare Provider Details

I. General information

NPI: 1316875248
Provider Name (Legal Business Name): BRENT MATTHEW HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7793 N LAKOTA RD
NORTH PLATTE NE
69101-8115
US

IV. Provider business mailing address

7793 N LAKOTA RD
NORTH PLATTE NE
69101-8115
US

V. Phone/Fax

Practice location:
  • Phone: 308-530-5335
  • Fax:
Mailing address:
  • Phone: 308-530-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License NumberH13971673
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: