MEDICARE: SANDRA A. HANSEN P.A-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA17386	CA

General Provider Information

NPI Number	:	1104871334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA A. HANSEN P.A-C

Provider Business Mailing Address
First Line	:	2340 CLAY ST
Second Line	:	4TH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1932
Country	:	US
Telephone Number	:	415-600-1016
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 CLAY ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1932
Country	:	US
Telephone Number	:	415-600-1016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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