MEDICARE: BRENDA G HANSON NP

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	163W00000X	Registered Nurse	116964	CO
2	367A00000X	Advanced Practice Midwife	CNM4129	CO
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.0996102-NP	CO

General Provider Information

NPI Number	:	1205994951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA G HANSON NP

Provider Business Mailing Address
First Line	:	1906 BLAKE AVE
Second Line	:	ATTN GABRIELA RAND- MEDICAL STAFF OFFICE
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4227
Country	:	US
Telephone Number	:	970-384-7033
Fax Number	:	970-384-8173

Provider Business Practice Location Address
First Line	:	1830 BLAKE AVENUE SUITE 208
Second Line	:
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4261
Country	:	US
Telephone Number	:	970-945-2238
Fax Number	:	970-928-8926

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	04/30/2021

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