Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 9050261-4405 | UT |
NPI | 1033698832 |
---|---|
Provider Name | Nicolette Carly Hansen |
First Address | Salt Lake City, UT 84103-3458 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |