Individual
JACQUELINE K HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
101 W WASHINGTON ST, MONTEZUMA, IA 50171-7739
(641) 623-5690
Mailing address
PO BOX 430, MONTEZUMA, IA 50171-0430
(641) 623-5690
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
A093734
IA
363LF0000X
Family Nurse Practitioner
Primary
A093734
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962485813
—
IA
Enumeration date
11/23/2005
Last updated
11/13/2023
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