Provider Demographics
NPI:1649481805
Name:HARNER, PATRICIA SUZANNE (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:SUZANNE
Last Name:HARNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-0310
Mailing Address - Country:US
Mailing Address - Phone:719-641-8950
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 310
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-0310
Practice Address - Country:US
Practice Address - Phone:719-641-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-26
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704144818163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08285845Medicaid
CO08285845Medicaid
COCOA109706Medicare PIN