Individual
KIMBERLY HASENBOEHLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
8923 GRUMMORE CIR, PIKESVILLE, MD 21208-1427
(720) 979-1002
Mailing address
8923 GRUMMORE CIR, PIKESVILLE, MD 21208-1427
(720) 979-1002
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
C04626
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8D9264
—
TX
Enumeration date
10/17/2006
Last updated
11/02/2011
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