Healthcare Provider Details

I. General information

NPI: 1366813438
Provider Name (Legal Business Name): ASHLEY R HARRIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11949 Q ST
OMAHA NE
68137-3503
US

IV. Provider business mailing address

11949 Q ST
OMAHA NE
68137-3503
US

V. Phone/Fax

Practice location:
  • Phone: 402-595-1326
  • Fax:
Mailing address:
  • Phone: 402-595-1326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number68826
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number111922
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: