Provider Demographics
NPI:1114548682
Name:HAROLD, DESIREE (RN)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:HAROLD
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 1:3527 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:URBANCREST
Mailing Address - State:OH
Mailing Address - Zip Code:43123-1944
Mailing Address - Country:US
Mailing Address - Phone:614-701-8034
Mailing Address - Fax:
Practice Address - Street 1:3527 4TH AVE
Practice Address - Street 2:
Practice Address - City:URBANCREST
Practice Address - State:OH
Practice Address - Zip Code:43123-1944
Practice Address - Country:US
Practice Address - Phone:614-701-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.437173163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse