Provider Demographics
NPI:1780934885
Name:HANSEN, CHRISTOPHER STEVEN (PA)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STEVEN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6677 W THUNDERBIRD RD STE I164
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-3762
Mailing Address - Country:US
Mailing Address - Phone:623-878-2100
Mailing Address - Fax:
Practice Address - Street 1:6677 W THUNDERBIRD RD STE I164
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-3762
Practice Address - Country:US
Practice Address - Phone:623-878-2100
Practice Address - Fax:623-696-3759
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-15
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016660183500000X
AZ6903363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty