Provider Demographics
NPI:1225746282
Name:HANSEN, STEPHANIE (CNM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18161 REDDING ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-7162
Mailing Address - Country:US
Mailing Address - Phone:760-680-8660
Mailing Address - Fax:
Practice Address - Street 1:18056 WIKA RD STE B
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2194
Practice Address - Country:US
Practice Address - Phone:760-813-3699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236310367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife