Provider Demographics
NPI:1558352054
Name:HANISCH, DEBRA G (RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:G
Last Name:HANISCH
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 WELCH RD STE 305
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1510
Mailing Address - Country:US
Mailing Address - Phone:650-498-7990
Mailing Address - Fax:650-724-4922
Practice Address - Street 1:750 WELCH RD
Practice Address - Street 2:#305
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1507
Practice Address - Country:US
Practice Address - Phone:650-498-7990
Practice Address - Fax:650-724-4922
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP10463363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP02334Medicare UPIN