Provider Demographics
NPI:1447339023
Name:HARSEN, DOROTHY L
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:L
Last Name:HARSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:L
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2240 W SUNSET ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6041
Mailing Address - Country:US
Mailing Address - Phone:417-209-2324
Mailing Address - Fax:417-269-9281
Practice Address - Street 1:2240 W SUNSET ST STE 104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6041
Practice Address - Country:US
Practice Address - Phone:417-209-2324
Practice Address - Fax:417-269-9281
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO090719363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429261704Medicaid
MO429261704Medicaid
P80024Medicare UPIN