Provider Demographics
NPI:1457774812
Name:HARMON, JENNIFER (BA)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S VALLEY VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-4361
Mailing Address - Country:US
Mailing Address - Phone:702-759-1279
Mailing Address - Fax:702-633-0975
Practice Address - Street 1:330 S VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-4361
Practice Address - Country:US
Practice Address - Phone:702-759-1279
Practice Address - Fax:702-633-0975
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker