Healthcare Provider Details

I. General information

NPI: 1932199981
Provider Name (Legal Business Name): JEFFREY A HANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 12/28/2023
Certification Date: 12/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12187 DEER FLAT RD
NAMPA ID
83686-9119
US

IV. Provider business mailing address

215 E HAWAII AVE
NAMPA ID
83686-6011
US

V. Phone/Fax

Practice location:
  • Phone: 208-880-0576
  • Fax:
Mailing address:
  • Phone: 208-463-3000
  • Fax: 208-463-3079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM5246
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: