Healthcare Provider Details

I. General information

NPI: 1194473702
Provider Name (Legal Business Name): BLANCHE NOELLE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2022
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 NC HIGHWAY 24 27 E
BISCOE NC
27209-9758
US

IV. Provider business mailing address

2265 NC HIGHWAY 24 27 E
BISCOE NC
27209-9758
US

V. Phone/Fax

Practice location:
  • Phone: 843-594-3246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF10210470
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5016009
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: