Provider Demographics
NPI:1740997287
Name:HARNOIS, JACKIE MARIE (RDH)
Entity type:Individual
Prefix:
First Name:JACKIE
Middle Name:MARIE
Last Name:HARNOIS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY DENTAL COMMAND
Mailing Address - Street 2:2240 E. WINROW AVE
Mailing Address - City:FORT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613
Mailing Address - Country:US
Mailing Address - Phone:520-533-3147
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL COMMAND
Practice Address - Street 2:2240 E. WINROW AVE
Practice Address - City:FORT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613
Practice Address - Country:US
Practice Address - Phone:520-533-3147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZH009965124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist