Healthcare Provider Details

I. General information

NPI: 1821896218
Provider Name (Legal Business Name): MICAELA LANGUERAND HANKES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 CHADBOURNE RD STE A
FAIRFIELD CA
94534-9620
US

IV. Provider business mailing address

470 CHADBOURNE RD STE A
FAIRFIELD CA
94534-9620
US

V. Phone/Fax

Practice location:
  • Phone: 707-419-8989
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95375475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: