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NPI Code Detail

MEDICARE: CHANELL HARRIS RN

MEDICARE: CHANELL 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
1163W00000XRegistered Nurse95411928CA

General Provider Information

NPI Number : 1487580635
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHANELL HARRIS RN
Provider Business Mailing Address
First Line : 16990 ALITA DR
Second Line :
City : RIVERSIDE
State : CA
Zip : 92504-6211
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3933 HARRISON ST
Second Line :
City : RIVERSIDE
State : CA
Zip : 92503-3523
Country : US
Telephone Number : 833-391-0505
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2026
Last Update Date : 06/23/2026

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