Provider Demographics
NPI:1609030923
Name:HANSON, KIM KAE (RN)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:KAE
Last Name:HANSON
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MAIL STOP 21110Q
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:651-254-6512
Mailing Address - Fax:651-254-3048
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-6512
Practice Address - Fax:651-254-3048
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2016-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNCRNA 0362367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered