Healthcare Provider Details

I. General information

NPI: 1831828409
Provider Name (Legal Business Name): JENNIFER HARMONRAGATZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 09/29/2026
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 E BLOOMFIELD RD
PHOENIX AZ
85032-7445
US

IV. Provider business mailing address

4030 E BLOOMFIELD RD
PHOENIX AZ
85032-7445
US

V. Phone/Fax

Practice location:
  • Phone: 602-670-4880
  • Fax:
Mailing address:
  • Phone: 602-670-4880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN086803
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: