Provider Demographics
NPI:1942376082
Name:HANSEN, CLARK H (NMD)
Entity Type:Individual
Prefix:DR
First Name:CLARK
Middle Name:H
Last Name:HANSEN
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13840 N NORTHSIGHT BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-3665
Mailing Address - Country:US
Mailing Address - Phone:991-480-5092
Mailing Address - Fax:480-991-2027
Practice Address - Street 1:13840 N NORTHSIGHT BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-3665
Practice Address - Country:US
Practice Address - Phone:991-480-5092
Practice Address - Fax:480-991-2027
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ87-384175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMH3151292OtherDEA