Provider Demographics
NPI:1023218591
Name:HARRIS, SECRET DENISE
Entity Type:Individual
Prefix:
First Name:SECRET
Middle Name:DENISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SECRET
Other - Middle Name:DENISE
Other - Last Name:MORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:201 SANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8774
Mailing Address - Country:US
Mailing Address - Phone:216-502-7822
Mailing Address - Fax:216-502-7877
Practice Address - Street 1:201 SANDOVER DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8774
Practice Address - Country:US
Practice Address - Phone:216-502-7877
Practice Address - Fax:216-502-7877
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 116595164W00000X
OHRN. 339649163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse