Healthcare Provider Details

I. General information

NPI: 1003316381
Provider Name (Legal Business Name): DEANNA HANSEN CO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEANNA WEAVER

II. Dates (important events)

Enumeration Date: 02/13/2018
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 CIVIC CENTER DR
REDDING CA
96001-2704
US

IV. Provider business mailing address

2102 CIVIC CENTER DR
REDDING CA
96001-2704
US

V. Phone/Fax

Practice location:
  • Phone: 530-241-4040
  • Fax: 530-241-4092
Mailing address:
  • Phone: 530-241-4040
  • Fax: 530-241-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: