Provider Demographics
NPI:1609554161
Name:HARNER, HOLLY (CRNP, WHNP)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:HARNER
Suffix:
Gender:F
Credentials:CRNP, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 W CLIVEDEN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3651
Mailing Address - Country:US
Mailing Address - Phone:267-270-8676
Mailing Address - Fax:
Practice Address - Street 1:3535 MARKET ST STE 100
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3376
Practice Address - Country:US
Practice Address - Phone:215-746-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004552G363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health