Healthcare Provider Details

I. General information

NPI: 1568825321
Provider Name (Legal Business Name): STEVEN DOUGLAS HANSEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2016
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 5TH AVE STE 323
SPOKANE WA
99204-2800
US

IV. Provider business mailing address

801 W 5TH AVE STE 323
SPOKANE WA
99204-2800
US

V. Phone/Fax

Practice location:
  • Phone: 509-724-4300
  • Fax: 509-755-6569
Mailing address:
  • Phone: 509-724-4300
  • Fax: 509-755-6569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberOP61026944
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: