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NPI Code Detail

MEDICARE: DOROTHEA BRADY HARRIS CRNP

MEDICARE: DOROTHEA BRADY HARRIS CRNP
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
1363L00000XNurse Practitioner1-137711AL

General Provider Information

NPI Number : 1578923520
Entity Type Code : Individual
Provider Name (Legal Business Name) : DOROTHEA BRADY HARRIS CRNP
Provider Business Mailing Address
First Line : 12101 WOODCREST EXECUTIVE DR STE 210
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63141-5047
Country : US
Telephone Number : 314-317-0600
Fax Number : 314-317-0606
Provider Business Practice Location Address
First Line : 1720 KNOWLES RD
Second Line :
City : PHENIX CITY
State : AL
Zip : 36869-7135
Country : US
Telephone Number : 314-317-0600
Fax Number : 314-317-0606
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2016
Last Update Date : 03/03/2016

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