Basic Information
| Provider Information | |||||||||
| NPI: | 1407474133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARWOOD | ||||||||
| FirstName: | ERIKA | ||||||||
| MiddleName: | LEA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | AGNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AGNITSCH | ||||||||
| OtherFirstName: | ERIKA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 115 S PARK AVE | ||||||||
| Address2: | |||||||||
| City: | EAGLE GROVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505332219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154485185 | ||||||||
| FaxNumber: | 5154484405 | ||||||||
| Practice Location | |||||||||
| Address1: | 115 S PARK AVE | ||||||||
| Address2: | |||||||||
| City: | EAGLE GROVE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505332219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5154485185 | ||||||||
| FaxNumber: | 5154484405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2020 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | H159559 | IA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
No ID Information.