Individual
ETHAN S HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2202 HARLEM RD STE 200, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 636-6125
Mailing address
2202 HARLEM RD STE 200, LOVES PARK, IL 61111-2754
(815) 877-4848
(815) 636-6125
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209019805
IL
Other
Enumeration date
06/19/2019
Last updated
08/12/2019
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