MEDICARE: ADREANNA 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
1	343900000X	Non-emergency Medical Transport (VAN)	TM917335	OH
2	347C00000X	Private Vehicle	TM917335	OH

General Provider Information

NPI Number	:	1700657129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADREANNA HARRIS

Provider Business Mailing Address
First Line	:	5834 SHADY COVE LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-2118
Country	:	US
Telephone Number	:	254-535-7562
Fax Number	:

Provider Business Practice Location Address
First Line	:	5834 SHADY COVE LN
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45426-2118
Country	:	US
Telephone Number	:	254-535-7562
Fax Number	:

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

Provider Enumeration Date	:	01/15/2024
Last Update Date	:	01/15/2024

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Directions to “ ADREANNA HARRIS ” Practice Location

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