MEDICARE: MRS. JENNIFER DENISE HARRIS 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	171M00000X	Case Manager/Care Coordinator	13-46991-032	KS

General Provider Information

NPI Number	:	1306008644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER DENISE HARRIS RN

Provider Business Mailing Address
First Line	:	3007 SE 28TH STREET TERRACE
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66605-1817
Country	:	US
Telephone Number	:	785-266-3461
Fax Number	:	785-266-3461

Provider Business Practice Location Address
First Line	:	3007 SE 28TH STREET TERRACE
Second Line	:
City	:	TOPEKA
State	:	KS
Zip	:	66605-1817
Country	:	US
Telephone Number	:	785-266-3461
Fax Number	:	785-266-3461

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

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	06/27/2008

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