Provider Demographics
NPI:1568535151
Name:KHALSA, HARI KAUR (FNP)
Entity Type:Individual
Prefix:
First Name:HARI
Middle Name:KAUR
Last Name:KHALSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-5606
Mailing Address - Country:US
Mailing Address - Phone:781-891-0051
Mailing Address - Fax:
Practice Address - Street 1:65 NEWBURYPORT TPKE
Practice Address - Street 2:HOLISTIC FAMILY PRACTICE, INC
Practice Address - City:NEWBURY
Practice Address - State:MA
Practice Address - Zip Code:01951-1113
Practice Address - Country:US
Practice Address - Phone:978-465-9770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA241223363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA92426OtherFALLON COMMUNITY HEALTH
MANP3717OtherBLUE CROSS BLUE SHIELD
S96663Medicare UPIN
MANP3717OtherBLUE CROSS BLUE SHIELD
MANP371702Medicare PIN
MANP3717Medicare ID - Type UnspecifiedFEDERAL