KIMBERLEY A HANNEKEN (NPI# 1215047782) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215047782 |
| Entity Type | Individual |
| Full Name | KIMBERLEY A HANNEKEN |
| Credential | MD |
| Practice Address |
260 Hospital Dr Suite 209 Ukiah CA 95482-4568 |
| Practice Telephone | 7074637488 |
| Practice Fax Number | 7074627846 |
| Mailing Telephone | 7074637488 |
| Mailing Fax Number | 7074627846 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-08-26 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
G136098 | CA | Allopathic & Osteopathic Physicians |
| N | 207QA0505X |
Family Medicine Specialization: Adult Medicine |
036094217 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE GROUP NPI | 1326041229 | 01 |
| IL | MEDICARE GROUP PTAN | 216239 | 01 |
| IL | 036094217 | 05 | |
| IL | HEALTH ALLIANCE | 1043486731 | 01 |
| Street Address |
260 HOSPITAL DR SUITE 209 |
| City | UKIAH |
| State | CA |
| Zip Code | 95482-4568 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609874445 | Jon Stephen Portnoff | Internal Medicine | 260 Hospital Dr, Suite 207, Ukiah, CA 95482-4533 | 2005-07-13 |
| 1114557345 | Shakuntala Blomquist | Nurse Practitioner | 260 Hospital Dr, Ukiah, CA 95482-4568 | 2020-01-15 |
| 1184175895 | Adventist Health Physicians Network | Pediatrics | 260 Hospital Dr, Suite 204, Ukiah, CA 95482-4568 | 2016-10-18 |
| 1447701156 | Adventist Health Physicians Network | Family Medicine | 260 Hospital Dr, Suite 209, Ukiah, CA 95482-4568 | 2016-10-18 |
| 1285185991 | Adventist Health Physicians Network | Internal Medicine | 260 Hospital Dr, Suite 103, Ukiah, CA 95482-4568 | 2016-10-18 |
| 1124499413 | Lori Katnik | Nurse Practitioner | 260 Hospital Dr, Ukiah, CA 95482-4568 | 2015-10-13 |
| 1053790915 | Adventist Health Physicians Network | Physical Medicine & Rehabilitation | 260 Hospital Dr, Suite 102, Ukiah, CA 95482-4568 | 2015-05-26 |
| 1659764777 | Adventist Health Physicians Network | Orthopaedic Surgery | 260 Hospital Dr, Suite 107, Ukiah, CA 95482-4568 | 2015-03-13 |
| 1609269984 | Adventist Health Physicians Network | Family Medicine | 260 Hospital Dr, Suite 207, Ukiah, CA 95482-4568 | 2015-03-11 |
| 1326431669 | Adventist Health Physicians Network | Urology | 260 Hospital Dr, Suite 201, Ukiah, CA 95482-4568 | 2015-03-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932726726 | Gloria Gonzalez Campise | Midwife | 205 W. Clay Street, Ukiah, CA 95482 | 2020-06-29 |
| 1083255095 | Mendocino Care Network | Internal Medicine | 1080 N State St, Ukiah, CA 95482 | 2019-10-01 |
| 1801383153 | Costco Wholesale Corporation | Pharmacy | 1275 Airport Park Blvd., Ukiah, CA 95482 | 2018-04-21 |
| 1922528256 | Ian David Winter | Case Manager/Care Coordinator | 1120 S. Dora St, Ukiah, CA 95482 | 2017-06-27 |
| 1568917938 | Rebecca Ann Dragomani | Nurse Practitioner | 260 Hospital Dr Ste 101, Ukiah, CA 95482 | 2016-08-16 |
| 1811362536 | Manzanita Services, Inc. | Community/Behavioral Health | 410 W. Jones St., Ukiah, CA 95482 | 2015-12-07 |
| 1689061061 | Pamela Mathias | Counselor | 367 East Gobbi Street, Suite E, Ukiah, CA 95482 | 2015-04-23 |
| 1275927030 | Jack David Segel | Counselor | 564 Dora St., Ste.d, Ukiah, CA 95482 | 2015-03-19 |
| 1689070211 | Mendocino County Youth Project | Clinic/Center | 347 Plum St, #b, Ukiah, CA 95482 | 2014-11-10 |
| 1346649951 | Ae Ran Ku | Dentist | 1096 South Dora Street, Ukiah, CA 95482 | 2014-08-19 |
| Find all providers in zip 95482 | ||||
| Taxonomy Code | 207QA0505X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Adult Medicine |
| Definition to come. |
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| 1457995565 | Ucsf Medical Group Business Services | Family Medicine | 1100 Park Pl Ste 100, San Mateo, CA 94403-7119 | 2019-10-31 |
| 1780237313 | Charles Kim Md Inc | Family Medicine | 3055 W Orange Ave Ste 204, Anaheim, CA 92804-3154 | 2019-07-23 |
| 1083277206 | Baum 5 Star Healthcare | Family Medicine | 560 W Grangeville Blvd Ste A, Hanford, CA 93230-2858 | 2019-04-15 |
| 1477025278 | Connexus Family Clinic Inc | Family Medicine | 1930 E. Anaheim Street, N/a, Long Beach, CA 90813-3908 | 2018-12-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.