Provider Demographics
NPI:1538136973
Name:HANSEN, KIM ANN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ANN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8014 NE 141ST ST
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5332
Mailing Address - Country:US
Mailing Address - Phone:425-821-9542
Mailing Address - Fax:
Practice Address - Street 1:16120 NE 87TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3505
Practice Address - Country:US
Practice Address - Phone:425-885-5581
Practice Address - Fax:425-869-9680
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00020250225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist