Healthcare Provider Details

I. General information

NPI: 1942758420
Provider Name (Legal Business Name): RORY JOHN HANSEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 N. 900 W. SUITE C
AMERICAN FORK UT
84003
US

IV. Provider business mailing address

10433 S REDWOOD RD STE 2
SOUTH JORDAN UT
84095-8502
US

V. Phone/Fax

Practice location:
  • Phone: 801-492-1611
  • Fax: 801-492-1480
Mailing address:
  • Phone: 801-260-1919
  • Fax: 801-260-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10085034-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: