Healthcare Provider Details

I. General information

NPI: 1144300922
Provider Name (Legal Business Name): KIMBERLY R HANSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 KENYON RD
FORT DODGE IA
50501-5759
US

IV. Provider business mailing address

720 KENYON RD
FORT DODGE IA
50501-5759
US

V. Phone/Fax

Practice location:
  • Phone: 515-955-7171
  • Fax: 515-573-7898
Mailing address:
  • Phone: 515-955-7171
  • Fax: 515-573-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number081312
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: