Provider Demographics
NPI:1194720649
Name:HARRISON, DANITA KAYE (DNP, ARNP)
Entity type:Individual
Prefix:DR
First Name:DANITA
Middle Name:KAYE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 LINCOLN RD STE 400
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-4159
Mailing Address - Country:US
Mailing Address - Phone:563-344-2240
Mailing Address - Fax:563-344-2244
Practice Address - Street 1:865 LINCOLN RD STE 400
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-4159
Practice Address - Country:US
Practice Address - Phone:563-344-2240
Practice Address - Fax:563-344-2244
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003631363L00000X
IAA062587363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
078691OtherHEALTH ALLIANCE
IA01D7OtherJOHN DEERE
IA0431296Medicaid
31157OtherWELLMARK BC/BS
IA0431296Medicaid
I14506Medicare PIN