1447485123 NPI number — DANIEL J. HANSEN, D.O., PLLC

Table of content: (NPI 1447485123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447485123 NPI number — DANIEL J. HANSEN, D.O., PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL J. HANSEN, D.O., PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHERN UTAH DERMATOLOGY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447485123
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1495 E RIDGELINE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH OGDEN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84405-4976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-399-3324
Provider Business Mailing Address Fax Number:
801-394-2807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1495 E RIDGELINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84405-4976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-399-3324
Provider Business Practice Location Address Fax Number:
801-394-2807
Provider Enumeration Date:
05/25/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
801-399-3324

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  71920331204 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QH0100X , with the licence number: 71920331204 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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