Provider Demographics
NPI:1508800624
Name:HARIRIE, PAULINE F (APNP)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:F
Last Name:HARIRIE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N27W23953 PAUL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-6243
Mailing Address - Country:US
Mailing Address - Phone:262-646-3223
Mailing Address - Fax:262-646-3443
Practice Address - Street 1:N27W23953 PAUL RD STE 101
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-6243
Practice Address - Country:US
Practice Address - Phone:262-646-3223
Practice Address - Fax:262-646-3443
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1842363L00000X
WI1842-33363LP2300X
WI86941363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36001800Medicaid