Healthcare Provider Details

I. General information

NPI: 1225768484
Provider Name (Legal Business Name): ELIZABETH WILSON HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2022
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 MILLSTONE DR
HILLSBOROUGH NC
27278-8776
US

IV. Provider business mailing address

309 W GEER ST APT 1
DURHAM NC
27701-2236
US

V. Phone/Fax

Practice location:
  • Phone: 919-245-5400
  • Fax:
Mailing address:
  • Phone: 919-308-5457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5016705
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number244025
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: