MEDICARE: PAMELA LYNNE HANSETH NP

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	163W00000X	Registered Nurse	727472	CA
2	363L00000X	Nurse Practitioner	95003169	CA

General Provider Information

NPI Number	:	1356720247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA LYNNE HANSETH NP

Provider Business Mailing Address
First Line	:	12062 VALLEY VIEW ST STE 140
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1777
Country	:	US
Telephone Number	:	714-406-5208
Fax Number	:	714-908-7521

Provider Business Practice Location Address
First Line	:	12062 VALLEY VIEW ST STE 140
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92845-1777
Country	:	US
Telephone Number	:	714-406-5208
Fax Number	:	714-908-7521

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

Provider Enumeration Date	:	05/25/2015
Last Update Date	:	02/10/2026

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