Provider Demographics
NPI:1144841446
Name:HARNAGE, THERESA LYNNE
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:LYNNE
Last Name:HARNAGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 TREVA ANNE DR SW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-3907
Mailing Address - Country:US
Mailing Address - Phone:704-281-6586
Mailing Address - Fax:863-241-0721
Practice Address - Street 1:2711 LANE ST
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-9217
Practice Address - Country:US
Practice Address - Phone:704-403-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC258408163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency