Healthcare Provider Details

I. General information

NPI: 1881574754
Provider Name (Legal Business Name): EILEEN B HANSON L.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 WILLIAM ST SE
ALBUQUERQUE NM
87102-4661
US

IV. Provider business mailing address

508 WESTERN SKIES DR SE
ALBUQUERQUE NM
87123-3776
US

V. Phone/Fax

Practice location:
  • Phone: 505-205-4053
  • Fax:
Mailing address:
  • Phone: 505-205-4053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberLN-1099
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberLN-1099
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: