Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | AP133484 | TX |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | COA.17272-NP | OH |
NPI | 1174910780 |
---|---|
Provider Name | Mackenzie Hansen |
First Address | Pearland, TX 77584-3733 |
Second Address | Houston, TX 77030-2358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2015 |
Last Update Date | 13/10/2018 |