Provider Demographics
NPI:1285962373
Name:HARNISCH, JEAN MARIE (RD)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:HARNISCH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:MARIE
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:5005 N PIEDRAS ST
Mailing Address - Street 2:WBAMC
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79920-5001
Mailing Address - Country:US
Mailing Address - Phone:915-569-1386
Mailing Address - Fax:915-569-4890
Practice Address - Street 1:5005 N PIEDRAS ST
Practice Address - Street 2:WBAMC
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79920-5001
Practice Address - Country:US
Practice Address - Phone:915-569-1386
Practice Address - Fax:915-569-4890
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT81325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered