Provider Demographics
NPI:1396422754
Name:HANSEN, JESSICA LYNN (PAC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:DOSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1608 S J ST FL 5
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4930
Mailing Address - Country:US
Mailing Address - Phone:253-274-7505
Mailing Address - Fax:253-274-7929
Practice Address - Street 1:1608 S J ST FL 5
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4930
Practice Address - Country:US
Practice Address - Phone:253-274-7505
Practice Address - Fax:253-274-7929
Is Sole Proprietor?:No
Enumeration Date:2023-06-28
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61503338363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant