Provider Demographics
NPI:1023191343
Name:HANSBERGER, JAMIE MARIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:MARIE
Last Name:HANSBERGER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 FALLS OF NEUSE RD STE 420
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6374
Mailing Address - Country:US
Mailing Address - Phone:651-246-3745
Mailing Address - Fax:
Practice Address - Street 1:4515 FALLS OF NEUSE RD STE 4320
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6290
Practice Address - Country:US
Practice Address - Phone:512-463-7456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 156736-4363LA2200X
NC5011239363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health