Provider Demographics
NPI:1891068581
Name:HANSON, JEFFREY (ND)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7925
Mailing Address - Country:US
Mailing Address - Phone:530-307-0164
Mailing Address - Fax:
Practice Address - Street 1:3121 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7925
Practice Address - Country:US
Practice Address - Phone:530-307-0164
Practice Address - Fax:530-452-1576
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
CAND477175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath