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General NPI Number Information
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NPI Number | 1003065897
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Entity Type | Individual
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Provider Name | JENNIFER LEE HANLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/16/2008
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Last Update Date | 11/30/2021
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Provider Practice Location Address
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Address Line | 6655 ALVARADO RD
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City | SAN DIEGO
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State | CA
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Zip | 92120-5208
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Country | US
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Telephone | 949-632-5442
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Fax |
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Provider Business Mailing Address
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Address Line | 6450 TOPMAST DR
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City | CARLSBAD
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State | CA
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Zip | 92011-1252
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Country | US
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Telephone | 949-632-5442
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 19927
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA19927
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License Number State | CA
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