Healthcare Provider Details

I. General information

NPI: 1508790114
Provider Name (Legal Business Name): CHRYSTAL ROSE HANSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 S PINES RD
SPOKANE VALLEY WA
99206-5753
US

IV. Provider business mailing address

2619 S PINES RD
SPOKANE VALLEY WA
99206-5753
US

V. Phone/Fax

Practice location:
  • Phone: 515-577-1270
  • Fax:
Mailing address:
  • Phone: 515-577-1270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License NumberBDC.BD.70104445
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: