Provider Demographics
NPI:1275376568
Name:HANSARD, HARRISON BLAKE
Entity type:Individual
Prefix:
First Name:HARRISON
Middle Name:BLAKE
Last Name:HANSARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3545 GRANDVIEW PKWY APT 301
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2073
Mailing Address - Country:US
Mailing Address - Phone:678-507-6443
Mailing Address - Fax:
Practice Address - Street 1:3545 GRANDVIEW PKWY APT 301
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2073
Practice Address - Country:US
Practice Address - Phone:678-507-6443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-185336163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse