Provider Demographics
NPI:1083002380
Name:HARLESS, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HARLESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:STE 460
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-0175
Mailing Address - Country:US
Mailing Address - Phone:614-566-9601
Mailing Address - Fax:614-566-8078
Practice Address - Street 1:285 E STATE ST
Practice Address - Street 2:STE 460
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4354
Practice Address - Country:US
Practice Address - Phone:614-566-9601
Practice Address - Fax:614-566-8078
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA-16826-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily