=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689214322
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RACHEL K HANSEN CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2020
-----------------------------------------------------
Last Update Date | 05/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1298 W FINNIE FLAT RD STE 101
-----------------------------------------------------
City | CAMP VERDE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 86322-5958
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-639-5555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9323 OSUNA PL NE
-----------------------------------------------------
City | ALBUQUERQUE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87111-2278
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 928-814-9489
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 58950
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 321597
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------