Healthcare Provider Details

I. General information

NPI: 1730101817
Provider Name (Legal Business Name): DAVID EDWARD HANSEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 918-712-9004
  • Fax: 918-712-9120
Mailing address:
  • Phone: 918-712-9004
  • Fax: 918-712-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number849
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: