Provider Demographics
NPI:1063992535
Name:HARNACK, STEPHANIE R (APRN, CNP)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:HARNACK
Suffix:
Gender:
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BEMIDJI AVE N
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3054
Mailing Address - Country:US
Mailing Address - Phone:218-308-2430
Mailing Address - Fax:218-326-0456
Practice Address - Street 1:800 BEMIDJI AVE N
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3054
Practice Address - Country:US
Practice Address - Phone:218-308-2430
Practice Address - Fax:218-326-0456
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6099363LP0808X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology