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Individual

KIMBERLEY A HANNEKEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
260 HOSPITAL DR, SUITE 209, UKIAH, CA 95482-4568
(707) 463-7488
(707) 462-7846
Mailing address
260 HOSPITAL DR, SUITE 209, UKIAH, CA 95482-4568
(707) 463-7488
(707) 462-7846

Taxonomy

Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
036094217
IL
207QA0505X
Adult Medicine Physician
Primary
G136098
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036094217
IL
01
1043486731
HEALTH ALLIANCE
IL
01
1326041229
MEDICARE GROUP NPI
IL
01
216239
MEDICARE GROUP PTAN
IL
Enumeration date
08/30/2006
Last updated
08/26/2015
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