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General NPI Number Information
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NPI Number | 1972721702
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Entity Type | Individual
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Provider Name | MARTHA LYNN HARRIS LPN
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 526 HART ST
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City | DAYTON
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State | OH
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Zip | 45404-1935
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Country | US
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Telephone | 937-718-7382
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Fax |
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Provider Business Mailing Address
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Address Line | 339 TURNER DR
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City | LEBANON
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State | OH
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Zip | 45036-1024
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Country | US
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Telephone | 513-932-7315
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | PN-026651
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License Number State | OH
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