Provider Demographics
NPI:1740948199
Name:MANSOOR, HASAN Y (FNP)
Entity type:Individual
Prefix:MR
First Name:HASAN
Middle Name:Y
Last Name:MANSOOR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6993 S UNION RD
Mailing Address - Street 2:
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-1648
Mailing Address - Country:US
Mailing Address - Phone:513-515-9807
Mailing Address - Fax:
Practice Address - Street 1:300 AUSTIN WEST BLVD
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-7519
Practice Address - Country:US
Practice Address - Phone:937-388-7959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.405767163WE0003X
OHAPRN.CNP.0027025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency