Provider Demographics
NPI:1750528261
Name:HARBIN, ALLICIA M (RN)
Entity type:Individual
Prefix:
First Name:ALLICIA
Middle Name:M
Last Name:HARBIN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 N GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53224-3320
Mailing Address - Country:US
Mailing Address - Phone:414-732-1326
Mailing Address - Fax:
Practice Address - Street 1:7950 N GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53224-3320
Practice Address - Country:US
Practice Address - Phone:414-732-1326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI155220-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse