Healthcare Provider Details

I. General information

NPI: 1831842160
Provider Name (Legal Business Name): AUDREY LYNN HARRIS MS, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2022
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE
ALBANY NY
12208-3478
US

IV. Provider business mailing address

87 GRANT AVE
GLENS FALLS NY
12801-2642
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3125
  • Fax:
Mailing address:
  • Phone: 518-926-8257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberF350547-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: