Healthcare Provider Details

I. General information

NPI: 1104916543
Provider Name (Legal Business Name): ORRIN BLAKE HANSEN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2006
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 E 50 S STE 241
AMERICAN FORK UT
84003-2849
US

IV. Provider business mailing address

58 N 750 E
AMERICAN FORK UT
84003-2086
US

V. Phone/Fax

Practice location:
  • Phone: 801-492-5999
  • Fax: 801-418-0897
Mailing address:
  • Phone: 801-850-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number282878-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: