MEDICARE: BRENT MATTHEW 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	385HR2065X	Child Physical Disabilities Respite Care	H13971673	NE

General Provider Information

NPI Number	:	1316875248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT MATTHEW HANSEN

Provider Business Mailing Address
First Line	:	7793 N LAKOTA RD
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-8115
Country	:	US
Telephone Number	:	308-530-5335
Fax Number	:

Provider Business Practice Location Address
First Line	:	7793 N LAKOTA RD
Second Line	:
City	:	NORTH PLATTE
State	:	NE
Zip	:	69101-8115
Country	:	US
Telephone Number	:	308-530-5335
Fax Number	:

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

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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