Provider Demographics
NPI:1891910170
Name:HANSEMANN, NICHOLAS AARON (LD)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:AARON
Last Name:HANSEMANN
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 COLTON DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-0265
Mailing Address - Country:US
Mailing Address - Phone:406-442-4899
Mailing Address - Fax:
Practice Address - Street 1:3365 COLTON DR UNIT A
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-0265
Practice Address - Country:US
Practice Address - Phone:406-442-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT150093Medicaid