NPI |
1629297973 |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Last Name Legal Name |
HANSEN |
The last name of the provider. If the provider is an individual, this is the legal name. |
Provider First Name |
DENISE |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Middle Name |
H |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
Provider Name Prefix Text |
MS. |
The city name in the location address of the provider being identified. |
Provider Credential Text |
PHYSICIAN ASSISTANT |
The State code in the location of the provider
being identified. |
Provider First Line Business Practice Location Address |
701 W 31ST ST |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address City Name |
HOUSTON |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
TX |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
770187509 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Country Code If outside U S |
US |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Telephone Number |
7138902080 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Enumeration Date |
4/25/2007 |
The first name of the authorized official. |
Last Update Date |
4/24/2024 |
The middle name of the authorized official. |
Provider Gender Code |
F |
The title or position of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
207XX0801X |
The 10-position telephone number of the authorized official. |
Provider License Number 1 |
PA05262 |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Provider License Number State Code 1 |
TX |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Primary Taxonomy Switch 1 |
N |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Taxonomy Code 2 |
363A00000X |
|
Provider License Number 2 |
23011818 |
|
Provider License Number State Code 2 |
NY |
|
Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
Healthcare Provider Taxonomy Code 3 |
363A00000X |
|
Provider License Number 3 |
PA05262 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Provider License Number State Code 3 |
TX |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
Healthcare Provider Primary Taxonomy Switch 3 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
NPI Certification Date |
4/24/2024 |
|