Provider Demographics
NPI:1073852059
Name:HANSEN, AMBER JOY (PA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:JOY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:TEKAMAH
Mailing Address - State:NE
Mailing Address - Zip Code:68061-1806
Mailing Address - Country:US
Mailing Address - Phone:402-685-6090
Mailing Address - Fax:402-808-4808
Practice Address - Street 1:1121 S 13TH ST
Practice Address - Street 2:
Practice Address - City:TEKAMAH
Practice Address - State:NE
Practice Address - Zip Code:68061-1806
Practice Address - Country:US
Practice Address - Phone:402-685-6090
Practice Address - Fax:402-808-4808
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1708363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical