Healthcare Provider Details

I. General information

NPI: 1467859942
Provider Name (Legal Business Name): JOANNA CATHERINE HARRIS NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/12/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

4001 FLAD AVE
ST. LOUIS MO
63110
US

V. Phone/Fax

Practice location:
  • Phone: 314-577-5631
  • Fax:
Mailing address:
  • Phone: 314-620-3489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2014040186
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: