Individual
JESSE HYRUM HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
415 6TH ST, LEWISTON, ID 83501-2434
(208) 750-7445
Mailing address
10604 E NATIVE ROSE TRL, TUCSON, AZ 85747-6020
(530) 331-0456
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
95099542
CA
367500000X
Certified Registered Nurse Anesthetist
Primary
62297
ID
Other
Enumeration date
08/10/2016
Last updated
09/20/2019
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