Healthcare Provider Details

I. General information

NPI: 1871721084
Provider Name (Legal Business Name): LILLIAN G. HARRIS RN, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 YANCEYVILLE ST # 66 SUITE 209
GREENSBORO NC
27405-5000
US

IV. Provider business mailing address

4252 HARBOR RIDGE DR
GREENSBORO NC
27406-8576
US

V. Phone/Fax

Practice location:
  • Phone: 336-691-1772
  • Fax: 336-691-1772
Mailing address:
  • Phone: 336-697-5470
  • Fax: 336-697-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number214499
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: