Healthcare Provider Details

I. General information

NPI: 1134034929
Provider Name (Legal Business Name): JASON HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2948 W MICHELLE DR
PHOENIX AZ
85053-1731
US

IV. Provider business mailing address

2948 W MICHELLE DR
PHOENIX AZ
85053-1731
US

V. Phone/Fax

Practice location:
  • Phone: 623-694-2901
  • Fax:
Mailing address:
  • Phone: 623-694-2901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number279139
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: