Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN1001X | Nutrition | 038.013606 | IL |
Y | 111NN1001X | Nutrition | 5567-12 | WI |
NPI | 1447855663 |
---|---|
Provider Name | Normajean L Harness |
First Address | Lake Geneva, WI 53147-2337 |
Second Address | Lake Geneva, WI 53147-2337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2020 |
Last Update Date | 03/12/2020 |