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NPI Code Detail

MEDICARE: SCOTT W HARRIS C.R.N.A.

MEDICARE: SCOTT W HARRIS C.R.N.A.
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
1367500000XCertified Registered Nurse Anesthetist140025-030WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2051052OTHERCRNA RECERTIFICATION CARD

General Provider Information

NPI Number : 1215912209
Entity Type Code : Individual
Provider Name (Legal Business Name) : SCOTT W HARRIS C.R.N.A.
Provider Business Mailing Address
First Line : PO BOX 735044
Second Line :
City : CHICAGO
State : IL
Zip : 60673-5044
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5000 MEMORIAL DR
Second Line :
City : TWO RIVERS
State : WI
Zip : 54241-3900
Country : US
Telephone Number : 920-794-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 05/30/2023

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