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Individual
KELLEN TAGE HANSEN
Active
Individual
KELLEN TAGE HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02004307A
IN
207Q00000X
Family Medicine Physician
02004307A
IN
207Q00000X
Family Medicine Physician
10266619-1204
UT
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
10266619-1204
UT
390200000X
Student in an Organized Health Care Education/Training Program
—
IN
Other
Enumeration date
06/14/2012
Last updated
11/21/2019
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