Individual
NICHOLAS GARY HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24 S 1100 E STE 310, SLC, UT 84102-1500
(801) 328-1260
(801) 350-4361
Mailing address
24 S 1100 E STE 310, SALT LAKE CITY, UT 84102-1500
(801) 328-1260
(801) 350-4361
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
84392901205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10161981
PHYSICIANS DOB
—
Enumeration date
06/30/2008
Last updated
01/12/2021
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