Provider Demographics
NPI:1962204149
Name:THOMSEN, IRIS MIDORI
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:MIDORI
Last Name:THOMSEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:MIDORI
Other - Last Name:HIRATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2145
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-2145
Mailing Address - Country:US
Mailing Address - Phone:684-254-7793
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2145
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-2145
Practice Address - Country:US
Practice Address - Phone:684-254-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS1284A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse