Individual
JOSHUA E HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1880 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4315
(208) 524-6633
Mailing address
1880 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4315
(208) 524-6633
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-927
ID
363AS0400X
Surgical Physician Assistant
PA-927
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1134140148
BAKER FAMILY PRACTICE NPI
—
Enumeration date
10/03/2011
Last updated
10/18/2011
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