Healthcare Provider Details

I. General information

NPI: 1801501671
Provider Name (Legal Business Name): ROBERT SHANE HANSON MSWI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1239 W 4200 N
ST GEORGE UT
84770-5982
US

IV. Provider business mailing address

474 W 200 N # 300
SAINT GEORGE UT
84770-4505
US

V. Phone/Fax

Practice location:
  • Phone: 801-997-5011
  • Fax:
Mailing address:
  • Phone: 435-634-5600
  • Fax: 435-986-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: