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General NPI Number Information
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NPI Number | 1598366577
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Entity Type | Individual
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Provider Name | BETHANIE DANIELLE HAKANSON NP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2020
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Last Update Date | 12/09/2022
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Provider Practice Location Address
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Address Line | 1700 COFFEE RD
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City | MODESTO
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State | CA
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Zip | 95355-2803
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Country | US
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Telephone | 209-202-6601
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 E MINNESOTA AVE
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City | TURLOCK
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State | CA
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Zip | 95382-1516
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Country | US
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Telephone | 209-202-6601
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95015528
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License Number State | CA
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