Healthcare Provider Details

I. General information

NPI: 1679835144
Provider Name (Legal Business Name): NANCY HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3106 W SAHUARO DR
PHOENIX AZ
85029-4242
US

IV. Provider business mailing address

3106 W SAHUARO DR
PHOENIX AZ
85029-4242
US

V. Phone/Fax

Practice location:
  • Phone: 773-420-6309
  • Fax:
Mailing address:
  • Phone: 773-420-6309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: