Provider Demographics
NPI:1255561973
Name:HARRIS, KAROLYN A (IDMT)
Entity type:Individual
Prefix:MRS
First Name:KAROLYN
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:105 GRANT CIR
Mailing Address - Street 2:STE 133
Mailing Address - City:OFFUTT A F B
Mailing Address - State:NE
Mailing Address - Zip Code:68113-4041
Mailing Address - Country:US
Mailing Address - Phone:402-294-7346
Mailing Address - Fax:402-294-9138
Practice Address - Street 1:105 GRANT CIR
Practice Address - Street 2:STE 133
Practice Address - City:OFFUTT A F B
Practice Address - State:NE
Practice Address - Zip Code:68113-2087
Practice Address - Country:US
Practice Address - Phone:402-294-7346
Practice Address - Fax:402-294-9138
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians