Provider Demographics
NPI:1295578847
Name:HANSON, MARY RUFFANER (CNP-BC (PMHNP))
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:RUFFANER
Last Name:HANSON
Suffix:
Gender:F
Credentials:CNP-BC (PMHNP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 COLLEGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-2103
Mailing Address - Country:US
Mailing Address - Phone:505-994-5050
Mailing Address - Fax:505-272-7882
Practice Address - Street 1:2600 COLLEGE AVE NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-2103
Practice Address - Country:US
Practice Address - Phone:505-994-5050
Practice Address - Fax:505-272-7882
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79337363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health