Provider Demographics
NPI:1013695295
Name:HANSON, SETH D (PA-C)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:D
Last Name:HANSON
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 1:4111 N 21ST ST APT 120
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6164
Mailing Address - Country:US
Mailing Address - Phone:602-577-1256
Mailing Address - Fax:
Practice Address - Street 1:6116 E ARBOR AVE STE 112
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-6103
Practice Address - Country:US
Practice Address - Phone:480-641-5400
Practice Address - Fax:480-218-4353
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9779363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty