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NPI Code Detail

MEDICARE: SUSAN HARRIS

MEDICARE: SUSAN HARRIS
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
1172V00000XCommunity Health WorkerAZ

General Provider Information

NPI Number : 1174361620
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUSAN HARRIS
Provider Business Mailing Address
First Line : PO BOX 966
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86405-0966
Country : US
Telephone Number : 928-855-6333
Fax Number : 928-855-5275
Provider Business Practice Location Address
First Line : 145 LAKE HAVASU AVE N
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-5616
Country : US
Telephone Number : 928-855-6333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2024
Last Update Date : 07/18/2024

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Directions to “ SUSAN HARRIS ” Practice Location

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