MEDICARE: MS. CASSONDRA MARIA HARRIS RN BSN

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	163W00000X	Registered Nurse	510555	OH
2	163W00000X	Registered Nurse	RN.510555	OH

General Provider Information

NPI Number	:	1518284140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASSONDRA MARIA HARRIS RN BSN

Provider Business Mailing Address
First Line	:	21751 PRIDAY AVE
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44123-2678
Country	:	US
Telephone Number	:	216-860-2003
Fax Number	:

Provider Business Practice Location Address
First Line	:	16243 EDGEWOOD CT
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-3967
Country	:	US
Telephone Number	:	216-624-7549
Fax Number	:

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

Provider Enumeration Date	:	04/21/2010
Last Update Date	:	12/26/2024

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