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NPI Code Detail

MEDICARE: MR. MARK HANSEN

MEDICARE: MR. MARK 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
1363L00000XNurse Practitioner5023244NC
2163W00000XRegistered Nurse295448NC

General Provider Information

NPI Number : 1255172862
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK HANSEN
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 291 BROAD ST
Second Line :
City : KERNERSVILLE
State : NC
Zip : 27284-2932
Country : US
Telephone Number : 336-993-8181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/06/2024
Last Update Date : 12/08/2025

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