Healthcare Provider Details

I. General information

NPI: 1588124093
Provider Name (Legal Business Name): JENNIFER HANES BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 03/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 N SLATER
MESA AZ
85205-5862
US

IV. Provider business mailing address

4041 S MCCLINTOCK DR STE 302
TEMPE AZ
85282-5879
US

V. Phone/Fax

Practice location:
  • Phone: 480-339-1780
  • Fax:
Mailing address:
  • Phone: 480-339-1780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN180289
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: