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NPI Code Detail

MEDICARE: CHRISTINA MARIE HARRIS LPN

MEDICARE: CHRISTINA MARIE HARRIS LPN
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
1164W00000XLicensed Practical Nurse314030-1NY

General Provider Information

NPI Number : 1528651452
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA MARIE HARRIS LPN
Provider Business Mailing Address
First Line : 595 W MAIN ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-1381
Country : US
Telephone Number : 315-788-1530
Fax Number :
Provider Business Practice Location Address
First Line : 595 W MAIN ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-1381
Country : US
Telephone Number : 315-788-1530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2021
Last Update Date : 02/11/2021

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