Provider Demographics
NPI:1710030952
Name:HANSEN, THOMAS M (ARNP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4229
Mailing Address - Country:US
Mailing Address - Phone:360-744-6250
Mailing Address - Fax:360-744-6296
Practice Address - Street 1:450 S KITSAP BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3773
Practice Address - Country:US
Practice Address - Phone:360-744-6250
Practice Address - Fax:360-744-6296
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9622242Medicaid
AB04452Medicare ID - Type Unspecified
WA9622242Medicaid