Provider Demographics
NPI:1871034371
Name:HANSEN, CATHRYN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CATHRYN
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 SE SAINT ANDREWS PL
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8421
Mailing Address - Country:US
Mailing Address - Phone:503-858-7403
Mailing Address - Fax:
Practice Address - Street 1:3838 SE SAINT ANDREWS PL
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97080-8421
Practice Address - Country:US
Practice Address - Phone:503-858-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR086000016RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse