Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207NS0135X | Procedural Dermatology | MT192221 | PA |
NPI | 1407048515 |
---|---|
Provider Name | Dr. Nathan William Hanson |
First Address | Salt Lake City, UT 84127-0128 |
Second Address | Logan, UT 84341-2400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2007 |
Last Update Date | 07/07/2009 |