Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist |
NPI | 1003316381 |
---|---|
Provider Name | Deanna Hansen |
First Address | Redding, CA 96001-2704 |
Second Address | Redding, CA 96001-2704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2018 |
Last Update Date | 30/06/2021 |