=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376527994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAN C HANKERSON MS CCCA FAAA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2005
-----------------------------------------------------
Last Update Date | 11/01/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 429 SE MARLIN AVE STE A
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97146-9649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-861-3235
-----------------------------------------------------
Fax | 503-861-3235
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 429 SE MARLIN AVE STE A
-----------------------------------------------------
City | WARRENTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97146-9649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-861-3235
-----------------------------------------------------
Fax | 503-861-3436
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | HASP584193
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 20434
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------