Healthcare Provider Details

I. General information

NPI: 1902678865
Provider Name (Legal Business Name): MICHELLE HANSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 9TH ST STE B
ALAMOGORDO NM
88310-6431
US

IV. Provider business mailing address

923 9TH ST STE B
ALAMOGORDO NM
88310-6431
US

V. Phone/Fax

Practice location:
  • Phone: 575-488-2720
  • Fax:
Mailing address:
  • Phone: 575-488-2720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1140058
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: