Provider Demographics
NPI:1386041044
Name:SHARE, TERRA HANSEN (NP)
Entity type:Individual
Prefix:
First Name:TERRA
Middle Name:HANSEN
Last Name:SHARE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERRA
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:701 SAN MATEO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1434
Mailing Address - Country:US
Mailing Address - Phone:505-265-9511
Mailing Address - Fax:
Practice Address - Street 1:111 11TH ST UNIT 102
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-879-2212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1629294163W00000X
COAPN0994880NP363L00000X
COAPN.0994880-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000177803Medicaid