Provider Demographics
NPI:1497328199
Name:HARREL, DENISE K
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:K
Last Name:HARREL
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 1:5917 N GALENA RD
Mailing Address - Street 2:
Mailing Address - City:SUNBURY
Mailing Address - State:OH
Mailing Address - Zip Code:43074-7622
Mailing Address - Country:US
Mailing Address - Phone:740-816-0958
Mailing Address - Fax:
Practice Address - Street 1:5917 N GALENA RD
Practice Address - Street 2:
Practice Address - City:SUNBURY
Practice Address - State:OH
Practice Address - Zip Code:43074-7622
Practice Address - Country:US
Practice Address - Phone:740-816-0958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0445507Medicaid