=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942376082
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLARK H. HANSEN N.M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/28/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13840 N NORTHSIGHT BLVD SUITE 105
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-3665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 991-480-5092
-----------------------------------------------------
Fax | 480-991-2027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13840 N NORTHSIGHT BLVD SUITE 105
-----------------------------------------------------
City | SCOTTSDALE
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85260-3665
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 991-480-5092
-----------------------------------------------------
Fax | 480-991-2027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175F00000X
-----------------------------------------------------
Taxonomy Name | Naturopath
-----------------------------------------------------
License Number | 87-384
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------