Healthcare Provider Details

I. General information

NPI: 1851122634
Provider Name (Legal Business Name): SUSAN GALE HARRIS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1664 N VIRGINIA ST # 146
RENO NV
89557-0146
US

IV. Provider business mailing address

1664 N VIRGINIA ST # 146
RENO NV
89557-0146
US

V. Phone/Fax

Practice location:
  • Phone: 775-784-8073
  • Fax: 775-784-7814
Mailing address:
  • Phone: 775-784-8073
  • Fax: 775-784-7814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: