Provider Demographics
NPI:1659379378
Name:HANSON, KRISTIN L (MD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:HANSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15640 N 28TH DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4059
Mailing Address - Country:US
Mailing Address - Phone:602-439-9000
Mailing Address - Fax:602-978-5233
Practice Address - Street 1:15640 N 28TH DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4059
Practice Address - Country:US
Practice Address - Phone:602-439-9000
Practice Address - Fax:602-978-5233
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21926207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21926OtherMEDICAL LICENSE
AZA00150187OtherDRIVERS LICENSE
AZ21926OtherMEDICAL LICENSE
AZBH3902435OtherDEA LICENSE
AZF75753Medicare UPIN
AZ62821Medicare ID - Type UnspecifiedMEDICARE ID