Healthcare Provider Details

I. General information

NPI: 1376456624
Provider Name (Legal Business Name): CHINA RENEE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8212 QUINN ST
DETROIT MI
48234-3608
US

IV. Provider business mailing address

8212 QUINN ST
DETROIT MI
48234-3608
US

V. Phone/Fax

Practice location:
  • Phone: 248-619-5306
  • Fax:
Mailing address:
  • Phone: 248-619-5306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number0813202232205
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: