Healthcare Provider Details

I. General information

NPI: 1366574196
Provider Name (Legal Business Name): WILLIAM HENRY HANSON PA-C, DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 N ROAD 68
PASCO WA
99301-9189
US

IV. Provider business mailing address

513 SE 8TH ST
COLLEGE PLACE WA
99324-1641
US

V. Phone/Fax

Practice location:
  • Phone: 509-543-9300
  • Fax:
Mailing address:
  • Phone: 509-200-1284
  • Fax: 509-783-2933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004866
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberP000000821
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: