Provider Demographics
NPI:1023371556
Name:HARRIS, DARIA LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:LYNN
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 1:8 E DEPEW AVE APT 3
Mailing Address - Street 2:PO BOX 104 AMHERST NY, 14226
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-1835
Mailing Address - Country:US
Mailing Address - Phone:716-984-6243
Mailing Address - Fax:
Practice Address - Street 1:8 E DEPEW AVE APT 3
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1835
Practice Address - Country:US
Practice Address - Phone:716-984-6243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292533164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY292533Medicaid