Provider Demographics
NPI:1467119016
Name:ALHARIRI, DANA (NP)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:ALHARIRI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 MADISON AVE APT 11
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2068
Mailing Address - Country:US
Mailing Address - Phone:203-543-0771
Mailing Address - Fax:
Practice Address - Street 1:115 TECHNOLOGY DR UNIT A103
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-6338
Practice Address - Country:US
Practice Address - Phone:914-589-6288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.009252363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty