Individual
TATE J HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
520 S EAGLE RD, STE 1222, MERIDIAN, ID 83642-6351
(208) 706-2200
(208) 706-2251
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-2222
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1047
ID
Other
Enumeration date
02/16/2013
Last updated
02/16/2013
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