Provider Demographics
NPI:1013030535
Name:HANSEN, ANDREW DRURY (PA - C)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:DRURY
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 GAGE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9701
Mailing Address - Country:US
Mailing Address - Phone:509-628-2331
Mailing Address - Fax:509-628-0537
Practice Address - Street 1:705 GAGE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-9701
Practice Address - Country:US
Practice Address - Phone:509-628-2331
Practice Address - Fax:509-628-0537
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004135363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical