Basic Information
Provider Information
NPI: 1730136417
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARMSEN
FirstName: NORA
MiddleName: KAY
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 630069
Address2: 730 LANAI AVE., STE #101
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: 05/28/2006
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDT1969HIY Dental ProvidersDentist 

ID Information
IDTypeStateIssuerDescription
49636605HI MEDICAID


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