Healthcare Provider Details

I. General information

NPI: 1932422904
Provider Name (Legal Business Name): DEBRA J HARRIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N MAPLE ST
EFFINGHAM IL
62401-2003
US

IV. Provider business mailing address

300 N MAPLE ST P.O. BOX 1268
EFFINGHAM IL
62401-2003
US

V. Phone/Fax

Practice location:
  • Phone: 217-342-4151
  • Fax: 217-342-4190
Mailing address:
  • Phone: 217-342-4151
  • Fax: 217-342-4190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209008065
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: