Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 125065152 | IL |
Y | 207L00000X | Anesthesiologist | 70654-20 | WI |
NPI | 1003236225 |
---|---|
Provider Name | John Henry Norman Harrison |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-1465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2014 |
Last Update Date | 19/01/2021 |