Provider Demographics
NPI:1053437004
Name:HANSEN, LISA (FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 W MARCH LN
Mailing Address - Street 2:SUITE #1
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5721
Mailing Address - Country:US
Mailing Address - Phone:209-478-2622
Mailing Address - Fax:209-870-2754
Practice Address - Street 1:89 W MARCH LN
Practice Address - Street 2:SUITE #1
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5721
Practice Address - Country:US
Practice Address - Phone:209-478-2622
Practice Address - Fax:209-870-2754
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN488598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP9830OtherFURNISHING LICENSE
CARN488598OtherRN LICENSE