Healthcare Provider Details

I. General information

NPI: 1851074637
Provider Name (Legal Business Name): KATIE HARRIS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W5282 AMY AVE
APPLETON WI
54915-7233
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-4600
  • Fax:
Mailing address:
  • Phone: 920-738-4600
  • Fax: 920-738-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14334-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: