Provider Demographics
NPI:1861584963
Name:ANDERSON-HANSEN, CAROLYN MARION (PA)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:MARION
Last Name:ANDERSON-HANSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 N TRIUMPH BLVD STE 330
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-7188
Mailing Address - Country:US
Mailing Address - Phone:385-345-3560
Mailing Address - Fax:
Practice Address - Street 1:3000 N TRIUMPH BLVD STE 330
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-7188
Practice Address - Country:US
Practice Address - Phone:385-345-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4034363A00000X
UT9076173-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty