Provider Demographics
NPI:1740391150
Name:HARDER, PAIGE A (RN /NP)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:A
Last Name:HARDER
Suffix:
Gender:F
Credentials:RN /NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 W IRONWOOD DRIVE
Mailing Address - Street 2:STE 206
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-667-4949
Mailing Address - Fax:208-765-0348
Practice Address - Street 1:980 W IRONWOOD DRIVE
Practice Address - Street 2:STE 206
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-667-4949
Practice Address - Fax:208-765-0348
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN33023163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDP67047Medicare UPIN