Provider Demographics
NPI:1134117153
Name:HANSON, RICHARD ENNISS JR (PA, MPAS)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ENNISS
Last Name:HANSON
Suffix:JR
Gender:M
Credentials:PA, MPAS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:33710 9TH AVE S STE 7
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6734
Mailing Address - Country:US
Mailing Address - Phone:253-517-7058
Mailing Address - Fax:
Practice Address - Street 1:33710 9TH AVE S STE 7
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6734
Practice Address - Country:US
Practice Address - Phone:253-517-7058
Practice Address - Fax:833-471-6226
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200266340AMedicaid
OK200266340AMedicaid