Healthcare Provider Details

I. General information

NPI: 1578274080
Provider Name (Legal Business Name): KARLA LEEANN HANSEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2199 N MERRIT CRK LOOP
COEUR D ALENE ID
83814-4949
US

IV. Provider business mailing address

1220 S NEWER RD
SPOKANE VALLEY WA
99037-9731
US

V. Phone/Fax

Practice location:
  • Phone: 208-665-7546
  • Fax:
Mailing address:
  • Phone: 509-710-0990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP61348708
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number67775
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number67775
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60717435
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: