Provider Demographics
NPI:1548543390
Name:HANSEN, JEANINE (RNP)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6507 MCNUTT WAY
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5360
Mailing Address - Country:US
Mailing Address - Phone:562-743-7014
Mailing Address - Fax:714-894-2520
Practice Address - Street 1:6507 MCNUTT WAY
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5360
Practice Address - Country:US
Practice Address - Phone:562-743-7014
Practice Address - Fax:714-894-2520
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6538363LW0102X
CARN127282363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health