Provider Demographics
NPI:1083188650
Name:HANSEN, RICHARD TORBEN
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:TORBEN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7041
Mailing Address - Country:US
Mailing Address - Phone:219-795-3360
Mailing Address - Fax:
Practice Address - Street 1:9001 BROADWAY
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7041
Practice Address - Country:US
Practice Address - Phone:219-795-3360
Practice Address - Fax:219-756-6500
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant