=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033035480
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARVEST HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2026
-----------------------------------------------------
Last Update Date | 06/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 116 W 1ST ST
-----------------------------------------------------
City | FAIRMONT
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56031-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-203-9935
-----------------------------------------------------
Fax | 507-203-9936
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 116 W 1ST ST
-----------------------------------------------------
City | FAIRMONT
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56031-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-203-9935
-----------------------------------------------------
Fax | 507-203-9936
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LORI ANN FETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 507-831-2500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------