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General NPI Number Information
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NPI Number | 1477903722
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Entity Type | Organization
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Legal Business Name | HANSEN FAMILY PRACTICE
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Dates
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Enumeration Date | 06/17/2016
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Last Update Date | 06/17/2016
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Provider Practice Location Address
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Address Line | 2300 12TH AVE S STE 10
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City | GREAT FALLS
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State | MT
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Zip | 59405-5017
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Country | US
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Telephone | 406-866-0280
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Fax | 406-866-0270
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Provider Business Mailing Address
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Address Line | 2300 12TH AVE S STE 10
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City | GREAT FALLS
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State | MT
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Zip | 59405-5017
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Country | US
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Telephone | 406-866-0280
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Fax | 406-866-0270
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Authorized Official
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Title or Position | OWNER
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Name | MRS. GINA COTTON HANSEN
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Credential | APRN, FNP-C
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Telephone | 406-866-0280
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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 | 100564
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License Number State | MT
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