Provider Demographics
NPI:1962074179
Name:HANSEN, EMILY J
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7856 MORNING DEW RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5637
Mailing Address - Country:US
Mailing Address - Phone:719-235-3504
Mailing Address - Fax:
Practice Address - Street 1:755 HIGHWAY 105 STE D
Practice Address - Street 2:
Practice Address - City:PALMER LAKE
Practice Address - State:CO
Practice Address - Zip Code:80133-8902
Practice Address - Country:US
Practice Address - Phone:719-235-3504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1638315163WA0400X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)