Provider Demographics
NPI:1922669357
Name:HANSEN, HEATHER ROGERS (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ROGERS
Last Name:HANSEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 KENBERMA ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-6000
Mailing Address - Country:US
Mailing Address - Phone:781-864-0527
Mailing Address - Fax:
Practice Address - Street 1:1279 S WILLOW ST STE E
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-4015
Practice Address - Country:US
Practice Address - Phone:603-644-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH075203-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily