Provider Demographics
NPI:1518904119
Name:HANSEN, DENISE MIRA (FNP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MIRA
Last Name:HANSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:997 OLD US HWY 70 W STE A
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-4505
Mailing Address - Country:US
Mailing Address - Phone:828-298-7981
Mailing Address - Fax:828-698-6010
Practice Address - Street 1:997 OLD US HWY 70 W STE A
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-4505
Practice Address - Country:US
Practice Address - Phone:828-698-7981
Practice Address - Fax:828-298-6010
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201689363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7950486Medicaid
P79542Medicare UPIN
2807492Medicare ID - Type Unspecified