Individual
MR. MARK HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
291 BROAD ST, KERNERSVILLE, NC 27284-2932
(336) 993-8181
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
295448
NC
363L00000X
Nurse Practitioner
Primary
5023244
NC
Other
Enumeration date
06/06/2024
Last updated
12/08/2025
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