Provider Demographics
NPI:1639504004
Name:J&P HARIRIE MIDLEVEL HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:J&P HARIRIE MIDLEVEL HEALTHCARE ASSOCIATES
Other - Org Name:ADVANCED LIPIDOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:F
Authorized Official - Last Name:HARIRIE
Authorized Official - Suffix:
Authorized Official - Credentials:APNP
Authorized Official - Phone:262-646-3223
Mailing Address - Street 1:N27W23953 PAUL RD
Mailing Address - Street 2:STE 101
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
Practice Address - Street 2:STE 101
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0019493-20207R00000X
WI207R00000X, 363AM0700X, 364SF0001X
WI838-023363AM0700X
WI1842-33364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI465050072OtherMEDICARE
WI36001800Medicaid
WI029770069OtherMEDICARE
WI465050072OtherMEDICARE