Provider Demographics
NPI:1982268819
Name:HANSEN, JIM (RN)
Entity Type:Individual
Prefix:
First Name:JIM
Middle Name:
Last Name:HANSEN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 E 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7475
Mailing Address - Country:US
Mailing Address - Phone:208-449-9545
Mailing Address - Fax:
Practice Address - Street 1:3581 E 1ST AVE
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7475
Practice Address - Country:US
Practice Address - Phone:208-449-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60919006163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse