Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1143 | OH |
NPI | 1578624235 |
---|---|
Provider Name | Dr. Jerry L Harnish |
First Address | Bellville, OH 44813-1021 |
Second Address | Bellville, OH 44813-1021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0603412 | (05) | OH |
T48261 | (02) | OH |