Healthcare Provider Details

I. General information

NPI: 1013473552
Provider Name (Legal Business Name): TRENTON JOHN HANSON APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4088 W 1820 S
SALT LAKE CITY UT
84104-4885
US

IV. Provider business mailing address

4088 W 1820 S
SALT LAKE CITY UT
84104-4885
US

V. Phone/Fax

Practice location:
  • Phone: 801-975-7799
  • Fax:
Mailing address:
  • Phone: 801-975-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7657194-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: