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General NPI Number Information
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NPI Number | 1225775802
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Entity Type | Individual
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Provider Name | BIANCA CHARESSE HARMON
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Gender | Female
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 1531 S KENNETH UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60623
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Country | US
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Telephone | 708-628-4207
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Fax |
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Provider Business Mailing Address
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Address Line | 7301 W 25TH ST UNIT 9
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City | NORTH RIVERSIDE
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State | IL
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Zip | 60546-1409
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Country | US
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Telephone | 708-628-4207
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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