Organization
GLENN A. HANSEN, D.P.M.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN A. HANSEN D.P.M. (SOLE PROPRIETOR)
(920) 499-1177
Entity
Organization
Contact information
Practice address
2331 S ONEIDA ST, GREEN BAY, WI 54304-5267
(920) 499-1177
(920) 499-5398
Mailing address
2331 S ONEIDA ST, GREEN BAY, WI 54304-5267
(920) 499-1177
(920) 499-5398
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
403-025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
43217500
—
WI
Enumeration date
02/12/2008
Last updated
02/12/2008
Update your record
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