Healthcare Provider Details

I. General information

NPI: 1356727069
Provider Name (Legal Business Name): ELISABETH ANNE HANSEN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 11TH AVE
LONGVIEW WA
98632-2506
US

IV. Provider business mailing address

1044 11TH AVE
LONGVIEW WA
98632-2506
US

V. Phone/Fax

Practice location:
  • Phone: 360-575-8275
  • Fax: 360-575-1943
Mailing address:
  • Phone: 360-575-8275
  • Fax: 360-575-8275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-76817-051
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60698673
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: