Provider Demographics
NPI:1770165318
Name:CHRISTMAN-HANNA, KIM LEAH (LPN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:LEAH
Last Name:CHRISTMAN-HANNA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8686 STATE ROUTE 685
Mailing Address - Street 2:
Mailing Address - City:GLOUSTER
Mailing Address - State:OH
Mailing Address - Zip Code:45732-9239
Mailing Address - Country:US
Mailing Address - Phone:740-767-2323
Mailing Address - Fax:
Practice Address - Street 1:8686 STATE ROUTE 685
Practice Address - Street 2:
Practice Address - City:GLOUSTER
Practice Address - State:OH
Practice Address - Zip Code:45732-9239
Practice Address - Country:US
Practice Address - Phone:740-767-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN098880164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse