Provider Demographics
NPI:1962446179
Name:HANSEN, JOHN C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PRINGLE WAY
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1464
Mailing Address - Country:US
Mailing Address - Phone:775-323-7500
Mailing Address - Fax:775-789-9208
Practice Address - Street 1:75 PRINGLE WAY
Practice Address - Street 2:SUITE 1002
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1464
Practice Address - Country:US
Practice Address - Phone:775-323-7500
Practice Address - Fax:775-789-9208
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV101322086S0129X, 2086S0127X, 2086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2016948Medicaid
NV2016948Medicaid
NVV36774Medicare UPIN