Healthcare Provider Details

I. General information

NPI: 1912996893
Provider Name (Legal Business Name): DEBRA LEE HANSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FOSTER RD
SANTA MARIA CA
93455-3620
US

IV. Provider business mailing address

PO BOX 1801
SANTA MARIA CA
93456-1801
US

V. Phone/Fax

Practice location:
  • Phone: 805-934-6900
  • Fax: 805-934-6901
Mailing address:
  • Phone: 805-801-2813
  • Fax: 805-934-6901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN315678
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-191819
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP8497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: