Provider Demographics
NPI:1740244748
Name:HARMON, AGNES (CNS)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:HARMON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27702 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1277
Mailing Address - Country:US
Mailing Address - Phone:708-957-8750
Mailing Address - Fax:708-957-8602
Practice Address - Street 1:19550 GOVERNORS HWY
Practice Address - Street 2:SUITE 2000
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-2125
Practice Address - Country:US
Practice Address - Phone:708-957-8750
Practice Address - Fax:708-957-8602
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000176A364SA2200X
IL209.010552364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01325484OtherRR MEDICARE
IN200532770Medicaid
ILF400437514OtherMEDICARE
IL476020Medicare PIN
IN200532770Medicaid