Provider Demographics
NPI:1861989261
Name:HIMEL, ELIZABETH N
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:N
Last Name:HIMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MICHIGAN AVE NE APT 33M
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-4313
Mailing Address - Country:US
Mailing Address - Phone:719-406-0421
Mailing Address - Fax:
Practice Address - Street 1:2235 W DEKALB ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2070
Practice Address - Country:US
Practice Address - Phone:800-996-6470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice