Healthcare Provider Details

I. General information

NPI: 1164463444
Provider Name (Legal Business Name): PATRICIA A. HARREN DR,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/10/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH 14-C
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

PO BOX 27036
NEW YORK NY
10087-7036
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0914
  • Fax: 212-305-4343
Mailing address:
  • Phone: 212-305-0914
  • Fax: 212-305-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF018591
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number381489-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number301859
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: