Provider Demographics
NPI:1922577964
Name:HERSON, DANIEL NICHOLAS
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:NICHOLAS
Last Name:HERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-421 HOKEA ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3332
Mailing Address - Country:US
Mailing Address - Phone:757-319-0185
Mailing Address - Fax:
Practice Address - Street 1:99-421 HOKEA ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3332
Practice Address - Country:US
Practice Address - Phone:757-319-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILPN-18525164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse