Healthcare Provider Details

I. General information

NPI: 1316990740
Provider Name (Legal Business Name): DAVID A. HANSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 NORDIC PL
FERNDALE WA
98248-9138
US

IV. Provider business mailing address

709 W ORCHARD DR SUITE 4
BELLINGHAM WA
98225-1766
US

V. Phone/Fax

Practice location:
  • Phone: 360-384-1511
  • Fax: 360-384-5758
Mailing address:
  • Phone: 360-318-8800
  • Fax: 360-318-1085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberML20007743
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: