Provider Demographics
NPI:1992233993
Name:HARMAN, JACQUELYN DARLENE (DO)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:DARLENE
Last Name:HARMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:DARLENE
Other - Last Name:MAUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:909 SW ORALABOR RD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-7004
Mailing Address - Country:US
Mailing Address - Phone:763-682-1313
Mailing Address - Fax:763-581-9090
Practice Address - Street 1:909 SW ORALABOR RD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-7004
Practice Address - Country:US
Practice Address - Phone:515-963-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAR-10942208000000X
MN66966208000000X
IADO-06649208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics