Provider Demographics
NPI:1932407699
Name:HARMON-INYANG, BRIGHTSTAR BJ
Entity Type:Individual
Prefix:
First Name:BRIGHTSTAR
Middle Name:BJ
Last Name:HARMON-INYANG
Suffix:
Gender:F
Credentials:
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 28262
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-0262
Mailing Address - Country:US
Mailing Address - Phone:612-961-7651
Mailing Address - Fax:
Practice Address - Street 1:427 VERMILLION ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1937
Practice Address - Country:US
Practice Address - Phone:612-961-7651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12-06-10225700000X
WI10630-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist