Provider Demographics
NPI:1366574196
Name:HANSON, WILLIAM HENRY (PA-C, DPM)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:HANSON
Suffix:
Gender:M
Credentials:PA-C, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:99324-1641
Mailing Address - Country:US
Mailing Address - Phone:509-200-1284
Mailing Address - Fax:509-783-2933
Practice Address - Street 1:5304 N ROAD 68
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-9189
Practice Address - Country:US
Practice Address - Phone:509-543-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004866363A00000X
WAP000000821213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
U17003Medicare UPIN