Serena Hansen
Individual provider Active NPI Pharmacist · Le Mars, IA
NPI 1154960078 · NPPES record last updated Dec 23, 2019
Key facts
- NPI
- 1154960078
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 22456 (IA)
- Practice address
- 1201 12TH Ave SW
Le Mars, IA 51031-3055 - Phone
- (712) 548-4503
- Fax
- (712) 546-4463
- NPI assigned
- Dec 23, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22456 | IA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 22456 | IA | Yes |
Addresses
Primary practice location
1201 12TH Ave SW
Le Mars, IA 51031-3055
Mailing address
1201 12TH Ave SW
Le Mars, IA 51031-3055
Phone (712) 548-4503
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22456 | Medicaid | IA |
Other providers in Le Mars, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.