Healthcare Provider Details

I. General information

NPI: 1437773751
Provider Name (Legal Business Name): MADELINE MARIE HANSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E 3900 S STE 260
SLC UT
84124-1371
US

IV. Provider business mailing address

6526 S 2425 E
COTTONWOOD HEIGHTS UT
84121-2608
US

V. Phone/Fax

Practice location:
  • Phone: 801-879-5900
  • Fax:
Mailing address:
  • Phone: 801-879-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10877623-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number108776233102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: