Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | S8997 | TX |
N | 207ND0101X | MOHS-Micrographic Surgeon | S8997 | TX |
NPI | 1326421603 |
---|---|
Provider Name | Dr. Jennifer Lynn Hanson |
First Address | Georgetown, TX 78633-1302 |
Second Address | Rochester, MN 55905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2015 |
Last Update Date | 03/02/2022 |