Provider Demographics
NPI:1386048791
Name:HARRINGTON, JAMIE ANN
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ANN
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:TYRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 194
Mailing Address - Street 2:
Mailing Address - City:PORT HENRY
Mailing Address - State:NY
Mailing Address - Zip Code:12974-0194
Mailing Address - Country:US
Mailing Address - Phone:518-546-3355
Mailing Address - Fax:
Practice Address - Street 1:4322 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT HENRY
Practice Address - State:NY
Practice Address - Zip Code:12974-1340
Practice Address - Country:US
Practice Address - Phone:518-546-3355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY805266174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist