Provider Demographics
NPI:1982697884
Name:HANSEN, MICHAEL L (PA C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
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Mailing Address - Street 1:9500 INDEPENDENCE DR
Mailing Address - Street 2:STE 900
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4600
Mailing Address - Country:US
Mailing Address - Phone:907-522-1341
Mailing Address - Fax:907-522-1343
Practice Address - Street 1:9500 INDEPENDENCE DR
Practice Address - Street 2:STE 900
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4600
Practice Address - Country:US
Practice Address - Phone:907-522-1341
Practice Address - Fax:907-522-1343
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2017-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AK220363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5248161OtherAETNA
S97567Medicare UPIN
K151173Medicare ID - Type Unspecified