Provider Demographics
NPI:1316150279
Name:HANSEN, PATTY STAHLE (RXN CNS)
Entity type:Individual
Prefix:MS
First Name:PATTY
Middle Name:STAHLE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RXN CNS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9485 W COLFAX
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215
Mailing Address - Country:US
Mailing Address - Phone:303-432-5200
Mailing Address - Fax:303-432-5260
Practice Address - Street 1:9485 W COLFAX
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:303-432-5200
Practice Address - Fax:303-432-5260
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORXN05024364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO74003330Medicaid