Individual
BRANDON JAMES HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
12391 S 4000 W, RIVERTON, UT 84096
(801) 302-1700
Mailing address
2965 W 3500 S, WEST VALLEY CITY, UT 84119-3602
(801) 965-3600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
4893
AZ
363AM0700X
Medical Physician Assistant
Primary
9210417-1206
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
840579
—
AZ
Enumeration date
09/23/2011
Last updated
01/22/2025
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