Healthcare Provider Details

I. General information

NPI: 1003594318
Provider Name (Legal Business Name): HARWINDER K DHANOA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 E EVERGREEN ST
SPRINGFIELD MO
65803-4300
US

IV. Provider business mailing address

3606 N THISTLEWOOD CT
SPRINGFIELD MO
65803-6401
US

V. Phone/Fax

Practice location:
  • Phone: 417-823-2900
  • Fax:
Mailing address:
  • Phone: 417-987-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2023025365
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023025365
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: