NPIMap

Individual provider Active NPI

Wanda Juarros Hanlon, M.D.

  • Family Medicine Physician
  • Bridgeport, CT
National Provider Identifier
1720034242
Registry record updated Jun 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
82035 Issued in CT
Practice address
64 Black Rock Ave
Bridgeport, CT 06605-1200
Phone
(203) 576-3885
NPI assigned
May 26, 2006
Last updated
Jun 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD60621875 WA
Family Medicine Physician 207Q00000X 26518 AZ
Family Medicine Physician 207Q00000X 82035 CT Primary

Addresses

Primary practice location

64 Black Rock Ave
Bridgeport, CT 06605-1200

Mailing address

514 Americas Way # 12464
Box Elder, SD 57719-7600

Other practice location 1

1718 E Kessler Blvd
Longview, WA 98632-1842
Phone (360) 747-5800

Other practice location 2

18 NW 20th Ave Ste 101
Battle Ground, WA 98604-4175
Phone (360) 952-4457

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
90.2 of 100Reported as group
Quality
84.35
Promoting interoperability
100
Improvement activities
40
Cost
79.93

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26518AZMDFamily Medicine Physician
82035CTMDFamily Medicine Physician
MD60621875WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Glendale Urgent Care LLC Past Accepting new patients
Nextcare Arizona LLC Past Accepting new patients
Nextcare Arizona I JV LLC Past Accepting new patients
Shea Urgent Care LLC Past Accepting new patients
Avondale Urgent Care LLC Past Accepting new patients
Peacehealth PastSince Oct 1, 2024 Accepting new patients
Pinnacle Medicine Inc. Past Accepting new patients
Arizona Medical Boutique, LLC Past Accepting new patients
Greenway Urgent Care LLC Past Accepting new patients
Dana Landing Urgent Care LLC Past Accepting new patients
Arizona Medical Boutique LLC PastSince Apr 30, 2003 Accepting new patients
Desert Ridge Urgent Care LLC Past Accepting new patients
Chandler Urgent Care LLC Past Accepting new patients
No Appointment MD Past Accepting new patients
Sun City Urgent Care LLC Past Accepting new patients

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1720034242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 AMERICAS WAY # 12464",
            "city": "BOX ELDER",
            "state": "SD",
            "postal_code": "577197600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64 BLACK ROCK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066051200",
            "telephone_number": "203-576-3885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1718 E Kessler Blvd",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986321842",
            "country_code": "US",
            "telephone_number": "360-747-5800",
            "fax_number": "360-575-3846",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "18 NW 20th Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Battle Ground",
            "state": "WA",
            "postal_code": "986044175",
            "country_code": "US",
            "telephone_number": "360-952-4457",
            "fax_number": "360-828-7409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANLON",
        "first_name": "WANDA",
        "middle_name": "JUARROS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-26",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD60621875",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "26518",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "82035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeport, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.