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General NPI Number Information
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NPI Number | 1962113548
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Entity Type | Individual
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Provider Name | KEVIN WADE-HANSON
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Gender | Male
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 01/04/2023
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Provider Practice Location Address
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Address Line | 10138 W PAYSON RD
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City | TOLLESON
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State | AZ
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Zip | 85353-8441
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Country | US
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Telephone | 414-759-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 10138 W PAYSON RD
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City | TOLLESON
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State | AZ
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Zip | 85353-8441
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Country | US
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Telephone | 414-759-7445
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1744R1102X
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Taxonomy Name | Research Study Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 246ZB0500X
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Taxonomy Name | Biochemist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 172A00000X
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Taxonomy Name | Driver
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License Number | D06300831
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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Taxonomy #5
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Taxonomy Code | 246ZB0301X
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Taxonomy Name | Biomedical Engineer
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License Number |
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