Provider Demographics
NPI:1235422767
Name:HARDING, DOROTHY TONJA (LPN)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:TONJA
Last Name:HARDING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CENTRAL AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-2248
Mailing Address - Country:US
Mailing Address - Phone:763-742-0836
Mailing Address - Fax:
Practice Address - Street 1:1706 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3614
Practice Address - Country:US
Practice Address - Phone:612-326-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL67315-2164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse