Provider Demographics
NPI:1578934014
Name:HANSEN, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 AVIATION WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-2059
Mailing Address - Country:US
Mailing Address - Phone:831-728-8259
Mailing Address - Fax:
Practice Address - Street 1:875 S COTTONWOOD RD STE 300
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-4208
Practice Address - Country:US
Practice Address - Phone:406-414-4100
Practice Address - Fax:406-414-4199
Is Sole Proprietor?:No
Enumeration Date:2015-10-09
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95003025363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics