Healthcare Provider Details

I. General information

NPI: 1518721695
Provider Name (Legal Business Name): IAN HANSEN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 N 1200 W # 1042
LAYTON UT
84041-5716
US

IV. Provider business mailing address

1706 N 1200 W # 1042
LAYTON UT
84041-5716
US

V. Phone/Fax

Practice location:
  • Phone: 801-382-7985
  • Fax: 385-284-1688
Mailing address:
  • Phone: 801-382-7985
  • Fax: 385-284-1688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9100218-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: