Provider Demographics
NPI:1093012452
Name:HANSON, JENNIFER CATHERINE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CATHERINE
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 CIVIC CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4151
Mailing Address - Country:US
Mailing Address - Phone:215-847-3133
Mailing Address - Fax:
Practice Address - Street 1:4000 CIVIC CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4151
Practice Address - Country:US
Practice Address - Phone:215-847-3133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116732208000000X
CA091309990390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program