Healthcare Provider Details

I. General information

NPI: 1700977139
Provider Name (Legal Business Name): KATHRYN A HANSEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 SEVEN LOCKS RD SUITE 111
ROCKVILLE MD
20854-2957
US

IV. Provider business mailing address

PO BOX 79632
BALTIMORE MD
21279-0632
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-5020
  • Fax: 301-294-7569
Mailing address:
  • Phone: 301-762-5020
  • Fax: 301-309-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR113593
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: