Provider Demographics
NPI:1366014813
Name:HANSEN, ADIA MAREN (RN)
Entity type:Individual
Prefix:
First Name:ADIA
Middle Name:MAREN
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 1:3580 W 9000 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8812
Mailing Address - Country:US
Mailing Address - Phone:801-561-8888
Mailing Address - Fax:801-561-8888
Practice Address - Street 1:3580 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8812
Practice Address - Country:US
Practice Address - Phone:801-561-8888
Practice Address - Fax:801-561-8888
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2023-06-08
Deactivation Date:2023-04-28
Deactivation Code:
Reactivation Date:2023-06-06
Provider Licenses
StateLicense IDTaxonomies
UT122967383101164W00000X
UT12296738-3102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse