Healthcare Provider Details

I. General information

NPI: 1477785731
Provider Name (Legal Business Name): DONNA CHRISTINE HARRIS APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 PARK AVE
MEMPHIS SHELBY COUNTY
38119
UM

IV. Provider business mailing address

2086 RIVERDALE RD
MEMPHIS TN
38138-4543
US

V. Phone/Fax

Practice location:
  • Phone: 901-764-3324
  • Fax: 901-765-3294
Mailing address:
  • Phone: 901-522-6249
  • Fax: 901-522-6249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAPN0000014309
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: