Provider Demographics
NPI:1114542008
Name:HANSEN, NICOLE DESIREE'
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DESIREE'
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-3980
Mailing Address - Country:US
Mailing Address - Phone:330-979-0920
Mailing Address - Fax:
Practice Address - Street 1:2012 JAMES ST
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-3980
Practice Address - Country:US
Practice Address - Phone:330-979-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide