Basic Information
| Provider Information | |||||||||
| NPI: | 1366675613 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORA K. HARMSEN, D.D.S., INC. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 630069 | ||||||||
| Address2: | |||||||||
| City: | LANAI CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967630069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085656418 | ||||||||
| FaxNumber: | 8085656742 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 LANAI AVENUE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LANAI CITY | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967630069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8085656418 | ||||||||
| FaxNumber: | 8085656742 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2009 | ||||||||
| LastUpdateDate: | 09/02/2009 | ||||||||
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| AuthorizedOfficialLastName: | HARMSEN | ||||||||
| AuthorizedOfficialFirstName: | NORA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8085656418 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.D.S. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | DT1969 | HI | Y | Ambulatory Health Care Facilities | Clinic/Center | Dental |
ID Information
| ID | Type | State | Issuer | Description | DT1969 | 05 | HI | MEDICAID |