Provider Demographics
NPI:1043236136
Name:HARRIS, NANCY L (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1852
Mailing Address - Country:US
Mailing Address - Phone:262-473-0400
Mailing Address - Fax:262-473-0408
Practice Address - Street 1:507 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1852
Practice Address - Country:US
Practice Address - Phone:262-473-0400
Practice Address - Fax:262-473-0408
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI39837-020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1043236136OtherBCBSWI
WI1043236136Medicaid
WIHARRINANOtherMERCYCARE INSURANCE
WI32432100Medicaid
WI1043236136Medicaid
WI1043236136Medicaid
WIHARRINANOtherMERCYCARE INSURANCE