Provider Demographics
NPI:1962834705
Name:HARRISON, KOLEENA JOON (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:KOLEENA
Middle Name:JOON
Last Name:HARRISON
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:KOLEENA
Other - Middle Name:MARIE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNP
Mailing Address - Street 1:3853 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-2737
Mailing Address - Country:US
Mailing Address - Phone:608-780-2554
Mailing Address - Fax:
Practice Address - Street 1:701 PARK AVE # G5.208
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55415-1623
Practice Address - Country:US
Practice Address - Phone:612-873-9892
Practice Address - Fax:612-873-4299
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR171916-7163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse