MEDICARE: MISS EMILY ANN HANSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1144963067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS EMILY ANN HANSEN

Provider Business Mailing Address
First Line	:	5008 W EQUESTRIAN PL APT 414
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-6111
Country	:	US
Telephone Number	:	605-359-9550
Fax Number	:

Provider Business Practice Location Address
First Line	:	5008 W EQUESTRIAN PL APT 414
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57106-6111
Country	:	US
Telephone Number	:	605-359-9550
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2022
Last Update Date	:	04/18/2022

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Directions to “ MISS EMILY ANN HANSEN ” Practice Location

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