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General NPI Number Information
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NPI Number | 1336776525
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Entity Type | Individual
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Provider Name | JANE ESCOLAS HARRELL MD
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Gender | Female
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 3003 W GOOD HOPE RD
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City | MILWAUKEE
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State | WI
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Zip | 53209-2042
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Country | US
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Telephone | 414-352-3100
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Fax | 414-247-4841
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Provider Business Mailing Address
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Address Line | PO BOX 735044
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City | CHICAGO
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State | IL
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Zip | 60673-5044
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Country | US
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Telephone | 800-326-2250
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 4351047329
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 83730
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 4351047329
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 260655
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License Number State | NC
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