Provider Demographics
NPI:1629505920
Name:HANSEN, KATRINA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:MARIE
Other - Last Name:ROTHRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5737 S ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2739
Mailing Address - Country:US
Mailing Address - Phone:480-215-1735
Mailing Address - Fax:
Practice Address - Street 1:5737 S ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2739
Practice Address - Country:US
Practice Address - Phone:480-215-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTLP053705164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse