Healthcare Provider Details

I. General information

NPI: 1629476189
Provider Name (Legal Business Name): KRISTINE HARRIS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2014
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 WATER ST SUITE 404
NORTH ANDOVER MA
01845-2648
US

IV. Provider business mailing address

120 WATER ST SUITE 404
NORTH ANDOVER MA
01845-2648
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-2460
  • Fax: 978-685-2572
Mailing address:
  • Phone: 978-685-2460
  • Fax: 978-685-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number211982
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN211982
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: