Healthcare Provider Details

I. General information

NPI: 1558352054
Provider Name (Legal Business Name): DEBRA G. HANISCH RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WELCH RD #305
PALO ALTO CA
94304-1507
US

IV. Provider business mailing address

750 WELCH RD STE 305
PALO ALTO CA
94304-1510
US

V. Phone/Fax

Practice location:
  • Phone: 650-498-7990
  • Fax: 650-724-4922
Mailing address:
  • Phone: 650-498-7990
  • Fax: 650-724-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP10463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: