MEDICARE: MRS. SERENA LEE HANSON

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	104100000X	Social Worker	7927	KS

General Provider Information

NPI Number	:	1245196963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SERENA LEE HANSON

Provider Business Mailing Address
First Line	:	1903 E HIGHRIDGE CT
Second Line	:
City	:	PARK CITY
State	:	KS
Zip	:	67219-4563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7570 W 21ST ST N STE B
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67205-1734
Country	:	US
Telephone Number	:	316-239-1880
Fax Number	:	316-558-8085

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

Provider Enumeration Date	:	12/26/2025
Last Update Date	:	12/26/2025

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