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1982944617
TATE J HANSEN
MERIDIAN, ID
NPI
1982944617
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: ID PA1047)
Enumeration Date
2013-02-16
Last Update Date
2013-02-16
Business Address
-- TATE J HANSEN PA-C
520 S EAGLE RD STE 1222
MERIDIAN, ID 83642-6351
Phone number: 208-706-2200
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Mailing Address
-- TATE J HANSEN PA-C
190 E BANNOCK ST
BOISE, ID 83712-6241
Phone number: 208-381-2222
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