Provider Demographics
NPI:1508333659
Name:HARLESS, TAMI RENEE
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:RENEE
Last Name:HARLESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:RENEE
Other - Last Name:HARLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 623
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:WV
Mailing Address - Zip Code:25570
Mailing Address - Country:US
Mailing Address - Phone:304-840-3970
Mailing Address - Fax:
Practice Address - Street 1:112 RIVERSIDE DRIVE DUNROVIN ESTATES
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570
Practice Address - Country:US
Practice Address - Phone:304-840-3970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-26
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant