Provider Demographics
NPI:1598825515
Name:HARRISH, ANGELA MARIE (PEDIATRIC NURSE PRAC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:HARRISH
Suffix:
Gender:F
Credentials:PEDIATRIC NURSE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14011 BENSON STREET
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66221
Mailing Address - Country:US
Mailing Address - Phone:913-912-1405
Mailing Address - Fax:
Practice Address - Street 1:5250 WEST 94TH TERRACE
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207
Practice Address - Country:US
Practice Address - Phone:913-451-0000
Practice Address - Fax:913-491-0547
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115839363LP0200X
KS53-75721-112363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics