Provider Demographics
NPI:1114905064
Name:HANCOCK, JANET SUE (FNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:SUE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEEL AVE
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4649
Mailing Address - Country:US
Mailing Address - Phone:575-418-5296
Mailing Address - Fax:
Practice Address - Street 1:200 NEEL AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4649
Practice Address - Country:US
Practice Address - Phone:575-418-5296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-01
Last Update Date:2013-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR42252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS93973Medicare UPIN