Healthcare Provider Details

I. General information

NPI: 1992730238
Provider Name (Legal Business Name): EDNA MAE HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 W ACEQUIA AVE # 2D
VISALIA CA
93291-6162
US

IV. Provider business mailing address

2706 W. ASHLAN AVE. SP25
FRESNO CA
93705-6471
US

V. Phone/Fax

Practice location:
  • Phone: 559-625-9100
  • Fax: 559-625-9103
Mailing address:
  • Phone: 559-430-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number425721
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN112310
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number425721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: