Individual
LARAE JEAN HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, PNP
Contact information
Practice address
7805 REDONDO ST, VENTURA, CA 93004-3814
(805) 452-8436
Mailing address
7805 REDONDO ST, VENTURA, CA 93004-3814
(805) 452-8436
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
95015281
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95015281
NP LICENSE
CA
Enumeration date
10/06/2020
Last updated
10/06/2020
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