Provider Demographics
NPI:1790774545
Name:HANSEN, KENDRA L (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 CAPITOL MALL DR SW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-8700
Mailing Address - Country:US
Mailing Address - Phone:360-705-1259
Mailing Address - Fax:360-705-2757
Practice Address - Street 1:3920 CAPITOL MALL DR SW
Practice Address - Street 2:SUITE 400
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-8700
Practice Address - Country:US
Practice Address - Phone:360-705-1259
Practice Address - Fax:360-705-2757
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003920207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMG0313685OtherDEA
WAMG0313685OtherDEA
WAAB21628Medicare ID - Type Unspecified