MEDICARE: DIANNE HARRIS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WS0200X	School Registered Nurse	627254	NY

General Provider Information

NPI Number	:	1104102680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE HARRIS RN

Provider Business Mailing Address
First Line	:	24 W KINGSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10468-7506
Country	:	US
Telephone Number	:	646-431-5057
Fax Number	:

Provider Business Practice Location Address
First Line	:	24 W KINGSBRIDGE RD
Second Line	:
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-4945
Country	:	US
Telephone Number	:	646-431-5057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2011
Last Update Date	:	10/27/2011

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