Healthcare Provider Details

I. General information

NPI: 1255519088
Provider Name (Legal Business Name): MRS. DEBORAH KIVETT HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2008
Last Update Date: 02/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 CAMERON DR
SANFORD NC
27332-9605
US

IV. Provider business mailing address

3110 CAMERON DR
SANFORD NC
27332-9605
US

V. Phone/Fax

Practice location:
  • Phone: 919-777-2903
  • Fax: 919-777-2904
Mailing address:
  • Phone: 919-777-2903
  • Fax: 919-777-2904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: