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General NPI Number Information
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NPI Number | 1619299310
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Entity Type | Individual
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Provider Name | CARRIE D HARRIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 08/16/2010
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Provider Practice Location Address
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Address Line | 71 HAYNES ST
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City | MANCHESTER
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State | CT
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Zip | 06040-4131
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Country | US
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Telephone | 860-646-1222
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Fax |
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Provider Business Mailing Address
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Address Line | 219 ANDERSON AVE
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City | MILFORD
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State | CT
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Zip | 06460-7104
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Country | US
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Telephone |
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 002377
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License Number State | CT
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