Healthcare Provider Details

I. General information

NPI: 1154837185
Provider Name (Legal Business Name): DAVID E HANSEN, PH.D, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5512 S LEWIS AVE STE 8
TULSA OK
74105-7140
US

IV. Provider business mailing address

5512 S LEWIS AVE STE 8
TULSA OK
74105-7140
US

V. Phone/Fax

Practice location:
  • Phone: 918-712-9004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State

VIII. Authorized Official

Name: EMGE HANSEN
Title or Position: OFFICE MANAGER
Credential:
Phone: 918-712-9004