Basic Information
| Provider Information | |||||||||
| NPI: | 1316150279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | PATTY | ||||||||
| MiddleName: | STAHLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RXN CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9485 W COLFAX | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325200 | ||||||||
| FaxNumber: | 3034325260 | ||||||||
| Practice Location | |||||||||
| Address1: | 9485 W COLFAX | ||||||||
| Address2: | |||||||||
| City: | LAKEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034325200 | ||||||||
| FaxNumber: | 3034325260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 04/19/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364S00000X | RXN05024 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
ID Information
| ID | Type | State | Issuer | Description | 74003330 | 05 | CO | MEDICAID |