Individual
HOLLEY R HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
351 DELNOR DR, GENEVA, IL 60134-4220
(630) 232-0280
(630) 232-3895
Mailing address
25 N WINFIELD RD, WINFIELD, IL 60190-1295
(630) 232-0280
(630) 232-3895
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209.010766
IL
363LF0000X
Family Nurse Practitioner
209010766
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE GROUP PTAN
IL
01
—
F400439285
MEDICARE INDIVIDUAL PTAN
IL
Enumeration date
10/03/2013
Last updated
09/12/2018
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