Healthcare Provider Details

I. General information

NPI: 1215009675
Provider Name (Legal Business Name): ALLYSON JORDAN HANSON RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801A W RANDOL MILL RD
ARLINGTON TX
76012-2565
US

IV. Provider business mailing address

231 WINDING HOLLOW LN
COPPELL TX
75019-2215
US

V. Phone/Fax

Practice location:
  • Phone: 817-275-3309
  • Fax: 817-265-0071
Mailing address:
  • Phone: 972-393-7690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number554839
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: