MEDICARE: MS. VANESSA E. HANSON CPT

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	246RP1900X	Phlebotomy Technician	2014-ID432	ID

General Provider Information

NPI Number	:	1568209401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VANESSA E. HANSON CPT

Provider Business Mailing Address
First Line	:	555 EXPRESSWAY DR APT 62
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2702
Country	:	US
Telephone Number	:	931-952-5647
Fax Number	:	844-463-7146

Provider Business Practice Location Address
First Line	:	555 EXPRESSWAY DR APT 62
Second Line	:
City	:	MANCHESTER
State	:	TN
Zip	:	37355-2702
Country	:	US
Telephone Number	:	931-952-5647
Fax Number	:	844-463-7146

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

Provider Enumeration Date	:	07/09/2024
Last Update Date	:	07/12/2024

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