Healthcare Provider Details

I. General information

NPI: 1154880789
Provider Name (Legal Business Name): BENJAMIN HANSSEN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 E 6TH ST STE 300
BONHAM TX
75418-4094
US

IV. Provider business mailing address

4307 PECAN LN
MELISSA TX
75454-2694
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-6155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP140792
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: