Provider Demographics
NPI:1023157948
Name:HANFORD, JESSICA RUTH (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RUTH
Last Name:HANFORD
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:RUTH
Other - Middle Name:JESSICA
Other - Last Name:HANFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:921 AUTUMN LANE,
Mailing Address - Street 2:#253 LAKE SAMISH TERRACE PARK
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229
Mailing Address - Country:US
Mailing Address - Phone:801-638-7834
Mailing Address - Fax:
Practice Address - Street 1:3015 SQUALICUM PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-676-1693
Practice Address - Fax:360-676-5458
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017457207Q00000X, 2083P0500X
UTG56706412052083X0100X
UT6567064-12052083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00017457OtherLICSENSE
UTG5670641205OtherUT LICENSE
WAMD00017457OtherLICSENSE