Individual
ELIJAH HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2800 W GORE BLVD, LAWTON, OK 73505-6320
(580) 581-2402
Mailing address
619 GREENE AVE., GREEN BAY, WI 54301
(920) 412-2711
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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