MEDICARE: KRISTINA M. HARBOUR

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
1	385HR2055X	Child Mental Illness Respite Care	455928	AZ

General Provider Information

NPI Number	:	1992973796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA M. HARBOUR

Provider Business Mailing Address
First Line	:	18042 W MORNING VISTA LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85387-6377
Country	:	US
Telephone Number	:	602-708-7105
Fax Number	:

Provider Business Practice Location Address
First Line	:	18042 W MORNING VISTA LN
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85387-6377
Country	:	US
Telephone Number	:	602-708-7105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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Directions to “ KRISTINA M. HARBOUR ” Practice Location

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