MEDICARE: KATRINA HARDER RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	855219	NY

General Provider Information

NPI Number	:	1063137818
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA HARDER RN

Provider Business Mailing Address
First Line	:	310 LIBERTY ST APT 35
Second Line	:
City	:	LITTLE FERRY
State	:	NJ
Zip	:	07643-1364
Country	:	US
Telephone Number	:	201-560-8868
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 WATER ST APT 401A
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-1401
Country	:	US
Telephone Number	:	914-435-7144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	10/04/2022

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