MEDICARE: TREVOR H. HANSEN PA-C

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
1	363A00000X	Physician Assistant	603	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	265126	OTHER	NE	PTAN
2	603	OTHER	NE	STATE LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568418341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TREVOR H. HANSEN PA-C

Provider Business Mailing Address
First Line	:	2114 N LINCOLN AVE
Second Line	:	SUITE A
City	:	YORK
State	:	NE
Zip	:	68467-1028
Country	:	US
Telephone Number	:	402-362-5555
Fax Number	:	402-362-7137

Provider Business Practice Location Address
First Line	:	2114 N LINCOLN AVE
Second Line	:	SUITE A
City	:	YORK
State	:	NE
Zip	:	68467-1028
Country	:	US
Telephone Number	:	402-362-5555
Fax Number	:	402-362-7137

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	04/29/2024

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