Provider Demographics
NPI:1457177693
Name:HANSEN, LESLIE K (RN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:K
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 1:1338 W REMINGTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-0892
Mailing Address - Country:US
Mailing Address - Phone:970-371-9344
Mailing Address - Fax:
Practice Address - Street 1:1338 W REMINGTON PARK DR
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-0892
Practice Address - Country:US
Practice Address - Phone:970-371-9344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0188225163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse