Healthcare Provider Details

I. General information

NPI: 1205254133
Provider Name (Legal Business Name): KRISTIN HANSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2014
Last Update Date: 03/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

612 SMOKE HOUSE RD
WEST CHESTER PA
19382-6127
US

V. Phone/Fax

Practice location:
  • Phone: 267-303-9504
  • Fax:
Mailing address:
  • Phone: 941-993-8635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number603808
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: