Provider Demographics
NPI:1629766811
Name:FADENRECHT, HANNAH BERNICE (DO)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:BERNICE
Last Name:FADENRECHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:551 WIKIUP DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1341
Mailing Address - Country:US
Mailing Address - Phone:480-375-8427
Mailing Address - Fax:
Practice Address - Street 1:2209 E 32ND ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404-4922
Practice Address - Country:US
Practice Address - Phone:253-593-0232
Practice Address - Fax:253-441-2695
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADOL.OL.61438768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine