Healthcare Provider Details

I. General information

NPI: 1063352995
Provider Name (Legal Business Name): ANGELICA JEAN ADAIR HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 KIRMAN AVE
RENO NV
89502-0993
US

IV. Provider business mailing address

785 PENNSYLVANIA DR
RENO NV
89503-3309
US

V. Phone/Fax

Practice location:
  • Phone: 775-328-1296
  • Fax:
Mailing address:
  • Phone: 775-304-1327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN91957
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: