Provider Demographics
NPI:1326175902
Name:HANSEN, STEPHANIE LYNN (PA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:7050 N RECREATION AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-8001
Mailing Address - Country:US
Mailing Address - Phone:559-322-2900
Mailing Address - Fax:559-322-2901
Practice Address - Street 1:7050 N RECREATION AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8001
Practice Address - Country:US
Practice Address - Phone:559-322-2900
Practice Address - Fax:559-322-2901
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA18536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18536Medicare UPIN