Healthcare Provider Details

I. General information

NPI: 1043459431
Provider Name (Legal Business Name): LAURIE ANNE HARRIS BS RN CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NORTHERN BLVD
ALBANY NY
12204-1004
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-447-3500
  • Fax: 518-447-3586
Mailing address:
  • Phone: 518-525-5634
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number451417
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: