Individual
JENNIFER LEIGH HANISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP
Contact information
Practice address
1111 E MCDOWELL RD, PHOENIX, AZ 85006-2612
(602) 839-2000
Mailing address
7314 S 26TH LN, PHOENIX, AZ 85041-6475
(623) 210-5830
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
PENDING
AZ
Other
Enumeration date
12/21/2019
Last updated
08/20/2021
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