Healthcare Provider Details

I. General information

NPI: 1417283813
Provider Name (Legal Business Name): JUDITH MARGARET HARRIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 10/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 LAFAYETTE DR NE
ALBUQUERQUE NM
87106-1120
US

IV. Provider business mailing address

1213 LAFAYETTE DR NE
ALBUQUERQUE NM
87106-1120
US

V. Phone/Fax

Practice location:
  • Phone: 505-249-5605
  • Fax:
Mailing address:
  • Phone: 505-249-5605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-01526
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: