1962834705 NPI number — KOLEENA JOON HARRISON APRN, CNP

Table of content: MARIA ISABEL FLORES (NPI 1649952631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962834705 NPI number — KOLEENA JOON HARRISON APRN, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRISON
Provider First Name:
KOLEENA
Provider Middle Name:
JOON
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
KOLEENA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, CNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962834705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 PARK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINNEAPOLIS
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55415-1623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
612-873-3000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 PARK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINNEAPOLIS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55415-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
612-873-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2013

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: 163W00000X , with the licence number:  R171916-7 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X , with the licence number: CNP3069 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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