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General NPI Number Information
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NPI Number | 1215506316
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Entity Type | Individual
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Provider Name | JAIME HANSEN FNP-C, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/22/2021
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 671 SW MAIN ST
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City | WINSTON
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State | OR
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Zip | 97496-6571
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Country | US
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Telephone | 541-672-2691
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1121
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City | ROSEBURG
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State | OR
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Zip | 97470-0254
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Country | US
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Telephone | 801-707-3755
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7197553-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 202108779NP-PP
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License Number State | OR
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