Provider Demographics
NPI:1376383794
Name:HANSEN, ALEXANDRA KILKENNY
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KILKENNY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 INTERNATIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2902
Mailing Address - Country:US
Mailing Address - Phone:510-434-5421
Mailing Address - Fax:
Practice Address - Street 1:12250 SKYLINE BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-2425
Practice Address - Country:US
Practice Address - Phone:510-531-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator