Healthcare Provider Details

I. General information

NPI: 1558064964
Provider Name (Legal Business Name): CHLOE HARLESS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 JOHN LLOYD EVANS MEMORIAL DR STE 200
NELSONVILLE OH
45764-2523
US

IV. Provider business mailing address

PO BOX 7527
DUBLIN OH
43017-0727
US

V. Phone/Fax

Practice location:
  • Phone: 740-753-7323
  • Fax: 740-753-7388
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number58.033407
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: