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NPI Code Detail

MEDICARE: JILL R. HANSEN MD

MEDICARE: JILL R. HANSEN MD
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
1207R00000XInternal Medicine PhysicianMD23299OR

Other Identifiers

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

General Provider Information

NPI Number : 1518050459
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL R. HANSEN MD
Provider Business Mailing Address
First Line : 232 NW 6TH AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97209-3609
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12121 E BURNSIDE ST
Second Line :
City : PORTLAND
State : OR
Zip : 97216-3737
Country : US
Telephone Number : 971-361-7700
Fax Number : 503-274-4815
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 11/21/2024

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