Provider Demographics
NPI:1851967558
Name:HARLAN, KAITLIN AMELIA
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:AMELIA
Last Name:HARLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2D DEN BN/NDC PSC 20130
Mailing Address - Street 2:315 MCHUGH BLVD
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL AMERICANO BASE NAVAL DE ROTA
Practice Address - Street 2:
Practice Address - City:ROTA
Practice Address - State:CADIZ
Practice Address - Zip Code:09645
Practice Address - Country:ES
Practice Address - Phone:956-727-3733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-02
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12081124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist