Provider Demographics
NPI:1699145862
Name:HANES, NATALIE ANNE (RN, NP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:ANNE
Last Name:HANES
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:BLAZIER
Other - Last Name:HANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, NP
Mailing Address - Street 1:1060 W SIERRA AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-2063
Mailing Address - Country:US
Mailing Address - Phone:559-437-1111
Mailing Address - Fax:559-437-1118
Practice Address - Street 1:1060 W SIERRA AVE STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-2063
Practice Address - Country:US
Practice Address - Phone:559-437-1111
Practice Address - Fax:559-437-1118
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95002639363LF0000X
CANPF95002639363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP95002639OtherCA NURSE PRACTIONER
CANPF95002639OtherCA NURSE PRACTITIONER FURNISHING NUMBER