Provider Demographics
NPI:1750660551
Name:HANSON, CAROL JEAN
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JEAN
Last Name:HANSON
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 1:1400 NADINE WAY
Mailing Address - Street 2:
Mailing Address - City:BOULDER CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89005-3352
Mailing Address - Country:US
Mailing Address - Phone:702-884-5947
Mailing Address - Fax:
Practice Address - Street 1:1445 AMERICAN PACIFIC DR
Practice Address - Street 2:#110-301
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7402
Practice Address - Country:US
Practice Address - Phone:702-744-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1194003269251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health