Provider Demographics
NPI:1013566595
Name:HARRISON, ANGELA (DNP)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 W RIVER ROCK LN
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:ID
Mailing Address - Zip Code:83714-8088
Mailing Address - Country:US
Mailing Address - Phone:208-867-2701
Mailing Address - Fax:
Practice Address - Street 1:10151 W RIVER ROCK LN
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:ID
Practice Address - Zip Code:83714-8088
Practice Address - Country:US
Practice Address - Phone:208-867-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID48826163W00000X
IDCNP62185363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse