Provider Demographics
NPI:1669872925
Name:HANSEN, NATHAN (DPM)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:
Last Name:HANSEN
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16030 BOTHELL EVERETT HWY STE 160
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1794
Mailing Address - Country:US
Mailing Address - Phone:425-537-3777
Mailing Address - Fax:425-407-5502
Practice Address - Street 1:16030 BOTHELL EVERETT HWY STE 160
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1794
Practice Address - Country:US
Practice Address - Phone:425-537-3777
Practice Address - Fax:425-407-5502
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-23
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60714901261QP1100X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric