Provider Demographics
NPI:1588168553
Name:HANSEN, KATRINA PAULINE (DO)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:PAULINE
Last Name:HANSEN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 LIMESTONE RD STE A
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-9178
Mailing Address - Country:US
Mailing Address - Phone:302-485-9995
Mailing Address - Fax:
Practice Address - Street 1:6300 LIMESTONE RD STE A
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-9178
Practice Address - Country:US
Practice Address - Phone:302-485-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025576207N00000X
MI5151013490390200000X
390200000X
DEC2-0024069207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program