Provider Demographics
NPI:1013909209
Name:HANSEN, KRISTEN NILS (RPH)
Entity Type:Individual
Prefix:MR
First Name:KRISTEN
Middle Name:NILS
Last Name:HANSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26455 WESTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-4626
Mailing Address - Country:US
Mailing Address - Phone:440-892-8084
Mailing Address - Fax:216-778-1055
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:WOMENS AND CHILDRENS PLAZA
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-8537
Practice Address - Fax:216-778-1055
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-12974183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist