Healthcare Provider Details

I. General information

NPI: 1992514780
Provider Name (Legal Business Name): BROOKS DOUGLAS HANSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 SE VILLAGE LOPP
VANCOUVER WA
98683
US

IV. Provider business mailing address

3505 NW 129TH ST
VANCOUVER WA
98685-2267
US

V. Phone/Fax

Practice location:
  • Phone: 360-601-3687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA228046
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: