Provider Demographics
NPI:1891068581
Name:HANSON, JEFF (ND)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3999 CEDAR AVE APT 39
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8957
Mailing Address - Country:US
Mailing Address - Phone:530-307-0164
Mailing Address - Fax:
Practice Address - Street 1:3097 HARRISON AVE STE 202
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8049
Practice Address - Country:US
Practice Address - Phone:530-307-0164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2012-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND477175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath