Provider Demographics
NPI:1881803724
Name:HANSEN, NEAL K
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:K
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 D 1 LOOP RD N
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-9202
Mailing Address - Country:US
Mailing Address - Phone:907-225-6445
Mailing Address - Fax:
Practice Address - Street 1:202 D1LOOP
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901
Practice Address - Country:US
Practice Address - Phone:907-225-6445
Practice Address - Fax:907-247-6445
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK268848332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK4406570001OtherMEDICARE NCS
AKMS2688OtherMEDICAID