Provider Demographics
NPI:1720398183
Name:HANSEN, INGRID I (FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:I
Last Name:HANSEN
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 THOMAS ST. CLINIC
Mailing Address - Street 2:SECOND FLOOR, TREATMENT ROOM
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009
Mailing Address - Country:US
Mailing Address - Phone:713-873-4089
Mailing Address - Fax:
Practice Address - Street 1:2615 FANNIN ST.
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002
Practice Address - Country:US
Practice Address - Phone:713-228-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily