MEDICARE: CERA MARIE HANSEN FNP-C

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	363L00000X	Nurse Practitioner	F03260026	UT

General Provider Information

NPI Number	:	1568319820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CERA MARIE HANSEN FNP-C

Provider Business Mailing Address
First Line	:	3493 N ANNABELL ST
Second Line	:
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005-6215
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3493 N ANNABELL ST
Second Line	:
City	:	EAGLE MOUNTAIN
State	:	UT
Zip	:	84005-6215
Country	:	US
Telephone Number	:	435-849-9328
Fax Number	:

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

Provider Enumeration Date	:	03/14/2026
Last Update Date	:	03/14/2026

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