Healthcare Provider Details

I. General information

NPI: 1134173271
Provider Name (Legal Business Name): CHERIE L HANSEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 WARREN ST
MADISONVILLE TN
37354-3001
US

IV. Provider business mailing address

1275 DICK LONAS RD UNIT 101
KNOXVILLE TN
37909-1383
US

V. Phone/Fax

Practice location:
  • Phone: 423-442-5480
  • Fax:
Mailing address:
  • Phone: 865-584-4747
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberOS8012
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8012
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: