1336733674 NPI number — JAN-MICHELLE EDENS HARNISH CFM

Table of content: JAN-MICHELLE EDENS HARNISH CFM (NPI 1336733674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336733674 NPI number — JAN-MICHELLE EDENS HARNISH CFM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARNISH
Provider First Name:
JAN-MICHELLE
Provider Middle Name:
EDENS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CFM
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:
1336733674
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 87067
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28304-7067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-323-9016
Provider Business Mailing Address Fax Number:
910-486-8712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2407 N ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-3658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-618-1935
Provider Business Practice Location Address Fax Number:
910-618-9920
Provider Enumeration Date:
02/26/2021

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: 224900000X , with the licence number:  CFM03434 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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