Provider Demographics
NPI:1528788965
Name:HANCOCK, HANNAH JEAN (APRN-CNP)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:JEAN
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:MISS
Other - First Name:HANNAH
Other - Middle Name:JEAN
Other - Last Name:LUNDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:6424 W EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7708
Mailing Address - Country:US
Mailing Address - Phone:802-881-7352
Mailing Address - Fax:
Practice Address - Street 1:4950 N BRADLEY ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-1478
Practice Address - Country:US
Practice Address - Phone:208-954-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID51057163W00000X
ID73477363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse