Provider Demographics
NPI:1669845582
Name:HANSEN, JANICE
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JANICE
Other - Middle Name:HANSEN
Other - Last Name:ZAKIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:290 CRYSTAL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-9664
Mailing Address - Country:US
Mailing Address - Phone:415-793-6354
Mailing Address - Fax:
Practice Address - Street 1:290 CRYSTAL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9664
Practice Address - Country:US
Practice Address - Phone:415-793-6354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85962174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist