Provider Demographics
NPI:1982393021
Name:HANSEN, WENDY (RN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ARDIS LOOP
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:MT
Mailing Address - Zip Code:59875-9700
Mailing Address - Country:US
Mailing Address - Phone:406-207-0331
Mailing Address - Fax:
Practice Address - Street 1:1986 N 1ST ST STE D
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3217
Practice Address - Country:US
Practice Address - Phone:406-530-7439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN-29804163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support