Basic Information
| Provider Information | |||||||||
| NPI: | 1164643102 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HARAMBEE NURSING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 S HANCOCK ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402032425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025840201 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 S HANCOCK ST | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402032425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025840201 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| AuthorizedOfficialLastName: | GOLDMAN | ||||||||
| AuthorizedOfficialFirstName: | MYRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY NURSE PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 5026410861 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3295P | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.