Provider Demographics
NPI:1154466803
Name:HARNISH, AUDREY (RN REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:
Last Name:HARNISH
Suffix:
Gender:F
Credentials:RN REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7241 E PINNACK PASS LOOP
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-759-2389
Mailing Address - Fax:
Practice Address - Street 1:HUMBOLDT UNIFIED SCHOOL DISTRICT #22 SPECIAL SRVCS OFIC
Practice Address - Street 2:8766 EAST HWY 69
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-4028
Practice Address - Fax:928-759-4030
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN116524163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ688533Medicaid