Healthcare Provider Details

I. General information

NPI: 1528378486
Provider Name (Legal Business Name): STEPHANIE L. HARRIS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N INDIAN CANYON DR
PALM SPRINGS CA
92262-4872
US

IV. Provider business mailing address

10 COMMERCE DR
NEW ROCHELLE NY
10801-5253
US

V. Phone/Fax

Practice location:
  • Phone: 760-323-6511
  • Fax:
Mailing address:
  • Phone: 914-637-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number164762-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number149475-4
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: