Provider Demographics
NPI:1013197763
Name:HARRIS, LA REINA NATALIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:LA REINA
Middle Name:NATALIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 N 29TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-2914
Mailing Address - Country:US
Mailing Address - Phone:414-342-9242
Mailing Address - Fax:414-342-9242
Practice Address - Street 1:1222 N 29TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-2914
Practice Address - Country:US
Practice Address - Phone:414-342-9242
Practice Address - Fax:414-342-9242
Is Sole Proprietor?:No
Enumeration Date:2007-11-10
Last Update Date:2007-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse