Basic Information
| Provider Information | |||||||||
| NPI: | 1831349919 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANAI | ||||||||
| FirstName: | DAVIS | ||||||||
| MiddleName: | ISAMI | ||||||||
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| Credential: | PHARMD, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3750 CHEMAWA RD NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0353047602 | ||||||||
| FaxNumber: | 8085377896 | ||||||||
| Practice Location | |||||||||
| Address1: | 3750 CHEMAWA RD NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973051198 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 0353047602 | ||||||||
| FaxNumber: | 8085377896 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2008 | ||||||||
| LastUpdateDate: | 04/12/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | RN63082 | HI | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 1835P2201X | RPH-0017197 | OR | Y |
No ID Information.