Healthcare Provider Details

I. General information

NPI: 1386048791
Provider Name (Legal Business Name): MRS. JAMIE ANN HARRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. JAMIE ANN TYRELL

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 10/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4322 MAIN ST
PORT HENRY NY
12974-1340
US

IV. Provider business mailing address

PO BOX 194
PORT HENRY NY
12974-0194
US

V. Phone/Fax

Practice location:
  • Phone: 518-546-3355
  • Fax:
Mailing address:
  • Phone: 518-546-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number805266
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: