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NPI Code Detail

MEDICARE: JEANNE HARRIS

MEDICARE:   JEANNE  HARRIS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianIL

General Provider Information

NPI Number : 1295825586
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEANNE HARRIS
Provider Business Mailing Address
First Line : 5101 N EXECUTIVE DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-4868
Country : US
Telephone Number : 309-692-1030
Fax Number : 309-692-3241
Provider Business Practice Location Address
First Line : 5101 N EXECUTIVE DR
Second Line :
City : PEORIA
State : IL
Zip : 61614-4868
Country : US
Telephone Number : 309-692-1030
Fax Number : 309-692-3241
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2006
Last Update Date : 07/09/2007

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Directions to “ JEANNE HARRIS ” Practice Location

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