Individual
KIMBERLEY J HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-6637
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-6637
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
25592
NC
2086S0102X
Surgical Critical Care Physician
25592
NC
2086S0129X
Vascular Surgery Physician
Primary
25592
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11647
PARTNERS
—
05
—
195448000
—
WV
01
—
24930
MEDCOST
—
01
—
39084
BCBS
—
01
—
4418530
AETNA
—
05
—
7323158
—
VA
05
—
8939084
—
NC
05
—
Q25592
—
SC
Enumeration date
12/15/2005
Last updated
11/12/2010
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