Healthcare Provider Details

I. General information

NPI: 1669814489
Provider Name (Legal Business Name): DAWN HANSEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 S 1470 E # 300
ST GEORGE UT
84790-1762
US

IV. Provider business mailing address

295 S 1470 E # 300
ST GEORGE UT
84790-1762
US

V. Phone/Fax

Practice location:
  • Phone: 435-674-0999
  • Fax:
Mailing address:
  • Phone: 435-674-0999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number335212-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: