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NPI Code Detail

MEDICARE: DR. JEFFREY JON HANSEN M.D.

MEDICARE: DR. JEFFREY JON HANSEN M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician36957WA

General Provider Information

NPI Number : 1356410419
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY JON HANSEN M.D.
Provider Business Mailing Address
First Line : 2215 BROADWAY ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3226
Country : US
Telephone Number : 360-906-7156
Fax Number :
Provider Business Practice Location Address
First Line : 2215 BROADWAY ST
Second Line :
City : VANCOUVER
State : WA
Zip : 98663-3226
Country : US
Telephone Number : 360-906-7156
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2006
Last Update Date : 07/08/2007

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