Jacqueline Fanchon Hanley

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95027396 Issued in CA

Practice address

1179 N McDowell Blvd
Petaluma, CA 94954-6559

Phone

(707) 559-7500

NPI assigned

Sep 26, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Interoperability endpoints

• Direct secure messaging: jhanley666888@direct.ochin.org

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

• Petaluma Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Petaluma, CA
  • NPI 1588656268
  NPD (past)

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

{
    "created_epoch": "1695686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695859200000",
    "number": "1982483152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANLEY",
        "first_name": "JACQUELINE",
        "middle_name": "FANCHON",
        "name_prefix": "Miss",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-26",
        "last_updated": "2023-09-28",
        "certification_date": "2023-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95027396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ronald Eugene Hammer, D.C.
• Cameron Alexander Hampton
• Miyah Hampton
• Kari Marie Hana
• Erin Hanauer, PA-C
• Madison Hanselman
• Forrest Hansen, RBT
• Leslie Carol Hansen, MFT
• Lisa Nicole Harb, DPT
• Sean Hardcaslte, DVM

• Family Nurse Practitioner in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.