Healthcare Provider Details

I. General information

NPI: 1356720247
Provider Name (Legal Business Name): PAMELA LYNNE HANSETH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2015
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6332 NEWBURY DR
HUNTINGTON BEACH CA
92647-6567
US

IV. Provider business mailing address

6332 NEWBURY DR
HUNTINGTON BEACH CA
92647-6567
US

V. Phone/Fax

Practice location:
  • Phone: 303-877-3847
  • Fax: 714-577-2125
Mailing address:
  • Phone: 303-877-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number727472
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95003169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: