Individual
MS. KIMBERLY A HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
109 W BLAND ST, ROSWELL, NM 88203-5708
(575) 623-1303
(575) 622-1303
Mailing address
PO BOX 1974, ROSWELL, NM 88202-1974
(575) 623-1303
(575) 622-1303
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
CNP00691
NM
363L00000X
Nurse Practitioner
R33452
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
R33452
STATE LICENSE NUMBER
NM
Enumeration date
08/08/2006
Last updated
02/04/2013
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