Healthcare Provider Details

I. General information

NPI: 1124780937
Provider Name (Legal Business Name): DEBORAH ANN HARRIS RPRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5998 PROVIDENCE RD STE 106A
VA BEACH VA
23464-3828
US

IV. Provider business mailing address

5998 PROVIDENCE RD STE 106A
VIRGINIA BEACH VA
23464-3828
US

V. Phone/Fax

Practice location:
  • Phone: 757-891-5922
  • Fax:
Mailing address:
  • Phone: 757-891-5922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number0735000380
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: