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General NPI Number Information
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NPI Number | 1215890702
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Entity Type | Individual
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Provider Name | CHERISSE ANN HANSEN
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Gender | Female
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Dates
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Enumeration Date | 12/03/2025
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Last Update Date | 12/03/2025
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Provider Practice Location Address
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Address Line | 302 3RD ST SE
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City | LOVELAND
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State | CO
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Zip | 80537-6419
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Country | US
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Telephone | 970-350-4602
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Fax | 970-350-4692
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Provider Business Mailing Address
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Address Line | 2930 11TH AVE
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City | EVANS
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State | CO
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Zip | 80620-1011
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Country | US
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Telephone | 970-350-4602
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Fax | 970-350-4692
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH000903633
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License Number State | CO
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