Healthcare Provider Details

I. General information

NPI: 1740228956
Provider Name (Legal Business Name): MARK ROY HANSEN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 INNOVATION DR
YORK PA
17408-8815
US

IV. Provider business mailing address

105 COLVARD CT
FOREST HILL MD
21050-1531
US

V. Phone/Fax

Practice location:
  • Phone: 574-849-3193
  • Fax:
Mailing address:
  • Phone: 574-849-3193
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN768704
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number074055
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: