Provider Demographics
NPI:1295315000
Name:HARNEY, ADAM MICHAEL (NDTR)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:HARNEY
Suffix:
Gender:M
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2642 SHENANDOAH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-2340
Mailing Address - Country:US
Mailing Address - Phone:217-899-2716
Mailing Address - Fax:
Practice Address - Street 1:11365 DORSETT RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3411
Practice Address - Country:US
Practice Address - Phone:314-872-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered