Healthcare Provider Details

I. General information

NPI: 1346363256
Provider Name (Legal Business Name): MISS DONNA LEWICE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 POPLAR STREET MURRAY -CALLOWAY COUNTY HOSPITAL
MURRAY KY
42071
US

IV. Provider business mailing address

715 S 7TH ST
PADUCAH KY
42003-1825
US

V. Phone/Fax

Practice location:
  • Phone: 270-762-1100
  • Fax:
Mailing address:
  • Phone: 270-442-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAO216
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: