1477821650 NPI number — DANA E HARMON NP

Table of content: DANA E HARMON NP (NPI 1477821650)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477821650 NPI number — DANA E HARMON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARMON
Provider First Name:
DANA
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477821650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
344 W ALLEGAN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OTSEGO
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49078-1086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-595-8782
Provider Business Mailing Address Fax Number:
269-694-1488

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 W ALLEGAN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OTSEGO
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49078-1086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
269-552-0100
Provider Business Practice Location Address Fax Number:
269-694-1488
Provider Enumeration Date:
12/02/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  4704225191 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)