Provider Demographics
NPI:1891954251
Name:HANSON, KELLI LYNN (RT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:LYNN
Last Name:HANSON
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40436 127TH ST
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:SD
Mailing Address - Zip Code:57445-5419
Mailing Address - Country:US
Mailing Address - Phone:605-380-3299
Mailing Address - Fax:605-622-2551
Practice Address - Street 1:40436 127TH ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:SD
Practice Address - Zip Code:57445-5419
Practice Address - Country:US
Practice Address - Phone:605-380-3299
Practice Address - Fax:605-622-2551
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2078362471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD207836OtherARRT