Provider Demographics
NPI:1497213425
Name:HANSEN, CAROLYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1287 SHADOW POINT DR APT 11
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-8051
Mailing Address - Country:US
Mailing Address - Phone:435-680-0558
Mailing Address - Fax:
Practice Address - Street 1:1068 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4477
Practice Address - Country:US
Practice Address - Phone:435-628-6466
Practice Address - Fax:435-628-3845
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9413881-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9413881-4405OtherSTATE APRN LICENSE