1346794864 NPI number — JENNALEE MARIE HARRIS PLMHP

Table of content: JENNALEE MARIE HARRIS PLMHP (NPI 1346794864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346794864 NPI number — JENNALEE MARIE HARRIS PLMHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
JENNALEE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PLMHP
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:
1346794864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6150 HIGHWAY 136 SUITE 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEBRON
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68370-7042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-853-3929
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6150 HIGHWAY 136 SUITE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEBRON
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-853-3929
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2016

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: 101YM0800X , with the licence number:  10966 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1346794864 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".