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General NPI Number Information
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NPI Number | 1366328197
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Entity Type | Individual
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Provider Name | HARRISON O IREDIA APN
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Gender | Male
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 23 WOOD THRUSH AVE
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-5275
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Country | US
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Telephone | 862-224-5279
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Fax |
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Provider Business Mailing Address
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Address Line | 23 WOOD THRUSH AVE
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-5275
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Country | US
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Telephone | 848-304-1631
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Fax | 949-849-9962
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 26NJ15373500
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License Number State | NJ
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