MEDICARE: LENA HARRISON FNP

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	363LF0000X	Family Nurse Practitioner	351572	NY

General Provider Information

NPI Number	:	1962103259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENA HARRISON FNP

Provider Business Mailing Address
First Line	:	15 N BROADWAY STE F
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-2222
Country	:	US
Telephone Number	:	914-948-4422
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 N BROADWAY STE F
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-2222
Country	:	US
Telephone Number	:	914-948-4422
Fax Number	:

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

Provider Enumeration Date	:	03/14/2023
Last Update Date	:	03/14/2023

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