Individual
MS. KAREN JANE BANDUSCH HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
405 KAYS DRIVE, NORMAL, IL 61761
(309) 862-0064
(309) 862-1542
Mailing address
1400 LISMORE LANE, NORMAL, IL 61761
(309) 888-9816
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085 000712
IL
363A00000X
Physician Assistant
Primary
085-000712
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
084278
HEALTH ALLIANCE
—
01
—
5723204
BCBS
—
01
—
588330
OSF HEALTH PLAN CP
—
05
—
588330
—
IL
01
—
CK5970
RR MEDIC
—
Enumeration date
11/02/2006
Last updated
01/15/2010
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