Healthcare Provider Details

I. General information

NPI: 1346291382
Provider Name (Legal Business Name): SUSAN MARIE HARRIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
US

IV. Provider business mailing address

504 1ST ST NE PO BOX 11
LAMOURE ND
58458-7212
US

V. Phone/Fax

Practice location:
  • Phone: 701-232-3241
  • Fax: 701-237-2625
Mailing address:
  • Phone: 701-883-5215
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR27105
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: