Provider Demographics
NPI:1447513486
Name:HANSEN, JENS ERIC (LMP)
Entity type:Individual
Prefix:MR
First Name:JENS
Middle Name:ERIC
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 13TH AVE E
Mailing Address - Street 2:APT #27
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-5856
Mailing Address - Country:US
Mailing Address - Phone:253-212-8111
Mailing Address - Fax:
Practice Address - Street 1:103 13TH AVE E
Practice Address - Street 2:APT #27
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-5856
Practice Address - Country:US
Practice Address - Phone:253-212-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60247390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist