MEDICARE: DR. LOREN KENT HANSEN DPM

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	213E00000X	Podiatrist	58	NV

General Provider Information

NPI Number	:	1558326462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOREN KENT HANSEN DPM

Provider Business Mailing Address
First Line	:	3885 S DECATUR BLVD
Second Line	:	SUITE 1080
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-6819
Country	:	US
Telephone Number	:	702-873-8955
Fax Number	:	702-873-6512

Provider Business Practice Location Address
First Line	:	3885 S DECATUR BLVD
Second Line	:	SUITE 1080
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-5855
Country	:	US
Telephone Number	:	702-873-8955
Fax Number	:	702-873-6512

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

Provider Enumeration Date	:	04/20/2006
Last Update Date	:	07/08/2007

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