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General NPI Number Information
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NPI Number | 1730482860
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Entity Type | Individual
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Provider Name | ALEXANDRA MARIE HARRIS RN
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Gender | Female
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Dates
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Enumeration Date | 12/12/2010
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 3304 COOLEY CT
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City | PORTAGE
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State | MI
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Zip | 49024-7430
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Country | US
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Telephone | 269-349-2266
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Fax | 269-349-0792
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Provider Business Mailing Address
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Address Line | 245 STATE ST SE STE 228
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-4328
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Country | US
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Telephone | 616-685-1808
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704247031
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 4704247031
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License Number State | MI
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