MEDICARE: AVON I HANSEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA10004255	WA

General Provider Information

NPI Number	:	1356367155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVON I HANSEN

Provider Business Mailing Address
First Line	:	UNIT 28216 BOX HOHENFELS
Second Line	:
City	:	APO
State	:	AE
Zip	:	09173-8216
Country	:	US
Telephone Number	:	314-590-3316
Fax Number	:

Provider Business Practice Location Address
First Line	:	UNIT 28216 BOX HOHENFELS
Second Line	:
City	:	APO
State	:	AE
Zip	:	09173-8216
Country	:	US
Telephone Number	:	314-590-3316
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/21/2024

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Directions to “ AVON I HANSEN ” Practice Location

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