Healthcare Provider Details

I. General information

NPI: 1447887260
Provider Name (Legal Business Name): MARIAN HARRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 MOREAU ST
MARKSVILLE LA
71351-2956
US

IV. Provider business mailing address

PO BOX 1288
WINNFIELD LA
71483-1288
US

V. Phone/Fax

Practice location:
  • Phone: 318-597-8991
  • Fax:
Mailing address:
  • Phone: 318-209-4910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number212202
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: