Individual
MIKAYLA HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-1944
Mailing address
630 S BAMBREY ST, PHILADELPHIA, PA 19146-1021
(484) 619-4471
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
MA065051
PA
Other
Enumeration date
10/27/2023
Last updated
10/17/2025
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