Provider Demographics
NPI:1790278141
Name:HANSON, TENNY (FNP)
Entity Type:Individual
Prefix:
First Name:TENNY
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TENNY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-212-7708
Mailing Address - Fax:307-352-8148
Practice Address - Street 1:3000 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-4202
Practice Address - Country:US
Practice Address - Phone:307-212-7708
Practice Address - Fax:307-352-8148
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY28504163W00000X
WY28504.1837363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse