Healthcare Provider Details

I. General information

NPI: 1396765772
Provider Name (Legal Business Name): MARILYN R HANSEN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 RICHMOND RD CENTER FOR SKILLED NURSING CARE
HIGHLAND HILLS OH
44122-6106
US

IV. Provider business mailing address

4310 RICHMOND RD CENTER FOR SKILLED NURSING CARE
HIGHLAND HILLS OH
44122-6106
US

V. Phone/Fax

Practice location:
  • Phone: 216-464-9500
  • Fax:
Mailing address:
  • Phone: 216-464-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberNP02348
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: