Provider Demographics
NPI:1063461879
Name:THURMAN, HARRY (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:
Last Name:THURMAN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2468 E SUMMER DAWN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7771
Mailing Address - Country:US
Mailing Address - Phone:208-206-5062
Mailing Address - Fax:208-206-5062
Practice Address - Street 1:2468 E SUMMERDAWN DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7771
Practice Address - Country:US
Practice Address - Phone:208-206-5062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP418A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805776202Medicaid
S61324Medicare UPIN
ID805776202Medicaid