MEDICARE: HARRISON BLAKE HANSARD

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	1-185336	AL

General Provider Information

NPI Number	:	1275376568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARRISON BLAKE HANSARD

Provider Business Mailing Address
First Line	:	3545 GRANDVIEW PKWY APT 301
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2073
Country	:	US
Telephone Number	:	678-507-6443
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 GRANDVIEW PKWY APT 301
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-2073
Country	:	US
Telephone Number	:	678-507-6443
Fax Number	:

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

Provider Enumeration Date	:	06/14/2024
Last Update Date	:	06/14/2024

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Directions to “ HARRISON BLAKE HANSARD ” Practice Location

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