Individual
ANNE G W HARLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3512 STELLHORN RD, FORT WAYNE, IN 46815-4631
(260) 483-9081
(260) 483-9196
Mailing address
214 PEARL ST, PENDLETON, IN 46064-1232
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
71006721A
IN
364SA2200X
Adult Health Clinical Nurse Specialist
71006721A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201405200
—
IN
01
—
P01751331
RR MEDICARE
IN
Enumeration date
10/12/2016
Last updated
03/16/2020
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