Healthcare Provider Details

I. General information

NPI: 1710265186
Provider Name (Legal Business Name): WENDY R HANSEN PTA, EMT-B
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 08/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 M ST
TEKAMAH NE
68061-1427
US

IV. Provider business mailing address

100 DIAMOND ST
ONAWA IA
51040-1929
US

V. Phone/Fax

Practice location:
  • Phone: 402-374-1414
  • Fax: 402-374-1601
Mailing address:
  • Phone: 712-423-1620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB-12-229-11
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number926
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number00646
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: