Healthcare Provider Details

I. General information

NPI: 1497276513
Provider Name (Legal Business Name): HANSEN FOOT AND ANKLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16030 BOTHELL EVERETT HWY STE 160
MILL CREEK WA
98012-1794
US

IV. Provider business mailing address

16030 BOTHELL EVERETT HWY STE 160
MILL CREEK WA
98012-1794
US

V. Phone/Fax

Practice location:
  • Phone: 425-537-3777
  • Fax: 425-407-5502
Mailing address:
  • Phone: 425-537-3777
  • Fax: 425-407-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO60714901
License Number StateWA

VIII. Authorized Official

Name: DIANA SALAZAR
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 425-537-3777