Healthcare Provider Details

I. General information

NPI: 1174564439
Provider Name (Legal Business Name): ROSE MARY HARRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S HIGH ST
NEWVILLE PA
17241-1409
US

IV. Provider business mailing address

100 S HIGH ST
NEWVILLE PA
17241-1409
US

V. Phone/Fax

Practice location:
  • Phone: 717-776-3114
  • Fax: 717-776-5020
Mailing address:
  • Phone: 717-776-3114
  • Fax: 717-776-5020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA002298L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: