Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 1171 | CA |
NPI | 1063597219 |
---|---|
Provider Name | Lynn C. Hansen |
First Address | Fountain Valley, CA 92708-3720 |
Second Address | Fountain Valley, CA 92708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 19/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00CNM11710 | (05) | CA |