Provider Demographics
NPI:1063819324
Name:HARLESS, MALINDA (RN)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:
Last Name:HARLESS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2242 BLAKERS BLVD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7807
Mailing Address - Country:US
Mailing Address - Phone:336-469-6320
Mailing Address - Fax:
Practice Address - Street 1:1050 RIBAUT RD
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5400
Practice Address - Country:US
Practice Address - Phone:843-524-3378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC177263163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse