MEDICARE: EMILY J 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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN.1638315	CO
2	163WH0200X	Home Health Registered Nurse	RN.1638315	CO

General Provider Information

NPI Number	:	1962074179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY J HANSEN

Provider Business Mailing Address
First Line	:	7856 MORNING DEW RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-5637
Country	:	US
Telephone Number	:	719-235-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 HIGHWAY 105 STE D
Second Line	:
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-8902
Country	:	US
Telephone Number	:	719-235-3504
Fax Number	:

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

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	07/15/2021

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