Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 6099 | MN |
NPI | 1063992535 |
---|---|
Provider Name | Stephanie Rae Harnack |
First Address | Duluth, MN 55802-2207 |
Second Address | Duluth, MN 55802-2207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 15/12/2018 |