Provider Demographics
NPI:1831262104
Name:BAHNSEN, KIM M (RN)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:BAHNSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 TOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORT MATILDA
Mailing Address - State:PA
Mailing Address - Zip Code:16870-7923
Mailing Address - Country:US
Mailing Address - Phone:814-692-7398
Mailing Address - Fax:
Practice Address - Street 1:501 HOWARD AVE STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4810
Practice Address - Country:US
Practice Address - Phone:814-942-1903
Practice Address - Fax:814-505-1100
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN543741L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015945850001Medicaid