Healthcare Provider Details

I. General information

NPI: 1144841446
Provider Name (Legal Business Name): THERESA LYNNE HARNAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 04/28/2020
Certification Date: 04/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 LANE ST
KANNAPOLIS NC
28083-9217
US

IV. Provider business mailing address

802 TREVA ANNE DR SW
CONCORD NC
28027-3907
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-4800
  • Fax:
Mailing address:
  • Phone: 704-281-6586
  • Fax: 863-241-0721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number258408
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: