Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 2008035460 | MO |
NPI | 1396978938 |
---|---|
Provider Name | Douglas John Harwood |
First Address | Saint Louis, MO 63110-1003 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2009 |
Last Update Date | 31/08/2009 |