Provider Demographics
NPI:1013579820
Name:HARMON, HOLLY E (PMHNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:E
Last Name:HARMON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 E 1050TH AVE
Mailing Address - Street 2:
Mailing Address - City:OBLONG
Mailing Address - State:IL
Mailing Address - Zip Code:62449-2409
Mailing Address - Country:US
Mailing Address - Phone:618-592-3119
Mailing Address - Fax:618-546-2602
Practice Address - Street 1:1366 E 1050TH AVE
Practice Address - Street 2:
Practice Address - City:OBLONG
Practice Address - State:IL
Practice Address - Zip Code:62449-2409
Practice Address - Country:US
Practice Address - Phone:618-592-3119
Practice Address - Fax:618-546-2602
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.019582363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health