1972668820 NPI number — MS. EVELYN JOAN HARN LMT

Table of content: MS. EVELYN JOAN HARN LMT (NPI 1972668820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972668820 NPI number — MS. EVELYN JOAN HARN LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARN
Provider First Name:
EVELYN
Provider Middle Name:
JOAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
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:
1972668820
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1790 POMELO DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34293-2716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-493-8596
Provider Business Mailing Address Fax Number:
941-493-8596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1540 BAY SHORE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOKOMIS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34275
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-485-8904
Provider Business Practice Location Address Fax Number:
941-485-4684
Provider Enumeration Date:
12/22/2006

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: 225700000X , with the licence number:  MA17155 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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