Healthcare Provider Details

I. General information

NPI: 1952090714
Provider Name (Legal Business Name): HARLEY KOCANJER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3299 E SOUTH RANGE RD
NEW SPRINGFIELD OH
44443-9726
US

IV. Provider business mailing address

3299 E SOUTH RANGE RD
NEW SPRINGFIELD OH
44443-9726
US

V. Phone/Fax

Practice location:
  • Phone: 330-314-6969
  • Fax:
Mailing address:
  • Phone: 330-314-6969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: