Healthcare Provider Details

I. General information

NPI: 1992973796
Provider Name (Legal Business Name): KRISTINA M. HARBOUR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RIO S. HARBOUR

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18042 W MORNING VISTA LN
SURPRISE AZ
85387-6377
US

IV. Provider business mailing address

18042 W MORNING VISTA LN
SURPRISE AZ
85387-6377
US

V. Phone/Fax

Practice location:
  • Phone: 602-708-7105
  • Fax:
Mailing address:
  • Phone: 602-708-7105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number455928
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: