Provider Demographics
NPI:1811197189
Name:HARMS, HEATHER ALISON (PHN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALISON
Last Name:HARMS
Suffix:
Gender:F
Credentials:PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 LA SELVA ST
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2109
Mailing Address - Country:US
Mailing Address - Phone:650-573-3480
Mailing Address - Fax:
Practice Address - Street 1:3080 LA SELVA ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2109
Practice Address - Country:US
Practice Address - Phone:650-573-3480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA698882163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA698882Medicaid
CA698882Medicare UPIN
CA698882Medicare PIN
CA698882Medicaid