Provider Demographics
NPI:1679702815
Name:HANSEN, ROSS STEWART (PAC)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:STEWART
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68784-5222
Mailing Address - Country:US
Mailing Address - Phone:402-287-2267
Mailing Address - Fax:
Practice Address - Street 1:301 E 7TH ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:NE
Practice Address - Zip Code:68784-5222
Practice Address - Country:US
Practice Address - Phone:402-287-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant