Healthcare Provider Details

I. General information

NPI: 1598378697
Provider Name (Legal Business Name): HANNAH SASSON GRUSHKOWSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 WILLOW LN # 206
THOUSAND OAKS CA
91361-4941
US

IV. Provider business mailing address

5922 CORBIN AVE
TARZANA CA
91356-1007
US

V. Phone/Fax

Practice location:
  • Phone: 601-376-9663
  • Fax:
Mailing address:
  • Phone: 818-448-1840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95009744
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95009744
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95009744
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: