Basic Information
| Provider Information | |||||||||
| NPI: | 1689145427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | KENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 35380 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891335380 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022427199 | ||||||||
| FaxNumber: | 7026674689 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 W CHARLESTON BLVD | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028778661 | ||||||||
| FaxNumber: | 7026674689 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2018 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | RN73141 | NV | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 163WC0200X | R047140 | SD | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 367500000X | 124913 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.