Individual
JAKE EDWIN HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
368 E 400 S, SMITHFIELD, UT 84335-1349
(435) 850-2821
Mailing address
368 E 400 S, SMITHFIELD, UT 84335-1349
(435) 850-2821
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2000055293
—
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000055293
BOARD OF CERTIFICATION FOR ATHLETIC TRAINERS
—
Enumeration date
01/17/2024
Last updated
01/08/2025
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