Provider Demographics
NPI:1669417333
Name:TERRI L. HARSCH
Entity type:Organization
Organization Name:TERRI L. HARSCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:HARSCH
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:435-714-1211
Mailing Address - Street 1:556 N SHORE DR LOT 3
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-1062
Mailing Address - Country:US
Mailing Address - Phone:435-714-1211
Mailing Address - Fax:
Practice Address - Street 1:556 N SHORE DR LOT 3
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-1062
Practice Address - Country:US
Practice Address - Phone:435-714-1211
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty