Provider Demographics
NPI:1558326462
Name:HANSEN, LOREN KENT (DPM)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:KENT
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 S DECATUR BLVD
Mailing Address - Street 2:SUITE 1080
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-6819
Mailing Address - Country:US
Mailing Address - Phone:702-873-8955
Mailing Address - Fax:702-873-6512
Practice Address - Street 1:3885 S DECATUR BLVD
Practice Address - Street 2:SUITE 1080
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-5855
Practice Address - Country:US
Practice Address - Phone:702-873-8955
Practice Address - Fax:702-873-6512
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV58213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVVDPM58Medicare ID - Type Unspecified
NVT67231Medicare UPIN