Healthcare Provider Details

I. General information

NPI: 1437877552
Provider Name (Legal Business Name): HEATHER LYNN HANSEN FNP-BC, AG-ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 ROUNTREE DR
CEDAR CITY UT
84720-3531
US

IV. Provider business mailing address

98 ROUNTREE DR
CEDAR CITY UT
84720-3531
US

V. Phone/Fax

Practice location:
  • Phone: 801-427-4239
  • Fax:
Mailing address:
  • Phone: 801-427-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number6590677-8900
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6590677-4405
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: