MEDICARE: MS. ELLEN M HANISCH NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	A-108210	IA
2	363L00000X	Nurse Practitioner	110748	NE
3	363L00000X	Nurse Practitioner	AP60134362	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	33314	OTHER	IA	WELLMARK
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346248754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN M HANISCH NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	1624 SOUTH I STREET
Second Line	:	SUITE 305
City	:	TACOMA
State	:	WA
Zip	:	98405-5093
Country	:	US
Telephone Number	:	253-428-8700
Fax Number	:	253-383-3376

Provider Business Practice Location Address
First Line	:	11511 CANTERWOOD BLVD
Second Line	:	SUITE 45
City	:	GIG HARBOR
State	:	WA
Zip	:	98332-5813
Country	:	US
Telephone Number	:	253-858-4725
Fax Number	:	253-858-4452

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	08/01/2012

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Directions to “ MS. ELLEN M HANISCH NURSE PRACTITIONER” Practice Location

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