Healthcare Provider Details

I. General information

NPI: 1942323472
Provider Name (Legal Business Name): NANCY LOUISE HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1138 ROSE HILL DR
CHARLOTTESVILLE VA
22903-5128
US

IV. Provider business mailing address

911 COPPER LINE RD
BUMPASS VA
23024-3026
US

V. Phone/Fax

Practice location:
  • Phone: 434-972-6219
  • Fax:
Mailing address:
  • Phone: 540-872-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024086149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: