Provider Demographics
NPI:1770814238
Name:HANSEN, JASON CONWAY (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:CONWAY
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 1:10231 S EAGLE CLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-4931
Mailing Address - Country:US
Mailing Address - Phone:801-856-3282
Mailing Address - Fax:
Practice Address - Street 1:1034 N 500 W
Practice Address - Street 2:UTAH VALLEY EMERGENCY PHYSICIANS
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604
Practice Address - Country:US
Practice Address - Phone:801-373-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-23
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant