Healthcare Provider Details

I. General information

NPI: 1336413368
Provider Name (Legal Business Name): DEANNA MARIE HANCOCK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2012
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6517 NE ALBERTA ST
PORTLAND OR
97218-3121
US

IV. Provider business mailing address

6517 NE ALBERTA ST
PORTLAND OR
97218-3121
US

V. Phone/Fax

Practice location:
  • Phone: 503-282-6856
  • Fax:
Mailing address:
  • Phone: 503-282-6856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number094000386RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number094000386RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: