Provider Demographics
NPI:1710171707
Name:HARMON, LOLITA IZETT (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:LOLITA
Middle Name:IZETT
Last Name:HARMON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3122
Mailing Address - Country:US
Mailing Address - Phone:269-208-3356
Mailing Address - Fax:
Practice Address - Street 1:401 MAPLE ST
Practice Address - Street 2:
Practice Address - City:BENTON HARBOR
Practice Address - State:MI
Practice Address - Zip Code:49022-4213
Practice Address - Country:US
Practice Address - Phone:269-208-3356
Practice Address - Fax:269-925-9001
Is Sole Proprietor?:No
Enumeration Date:2007-09-01
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN142204163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency