Provider Demographics
NPI:1659156032
Name:HANSEN, BRIAN J (PMHNP)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 W BROAD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2215
Mailing Address - Country:US
Mailing Address - Phone:804-282-1863
Mailing Address - Fax:
Practice Address - Street 1:6010 W BROAD ST STE 103
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2215
Practice Address - Country:US
Practice Address - Phone:262-282-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-25
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190492363LP0808X
WI14281-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health