Healthcare Provider Details

I. General information

NPI: 1376151712
Provider Name (Legal Business Name): LIANA ANGELICA HANSEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 RED HILL RD
MIDDLETOWN NJ
07748-3052
US

IV. Provider business mailing address

267 THOUSAND OAKS DR
ATLANTIC HIGHLANDS NJ
07716-2455
US

V. Phone/Fax

Practice location:
  • Phone: 848-800-5913
  • Fax:
Mailing address:
  • Phone: 516-457-4505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00721500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: