Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 270597 | CA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 270597 | CA |
N | 363LC1500X | Nurse Practitioner - Community Health | 270597 | CA |
N | 363LP2300X | Nurse Practitioner - Primary Care | 270597 | CA |
NPI | 1992767628 |
---|---|
Provider Name | Holly Rae Hansen |
First Address | San Mateo, CA 94403-3649 |
Second Address | Palo Alto, CA 94304-1207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 08/07/2007 |