Provider Demographics
NPI:1043441074
Name:HARRIS, MARYLYN RENEE (RN)
Entity Type:Individual
Prefix:MS
First Name:MARYLYN
Middle Name:RENEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5330 GRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3700
Mailing Address - Country:US
Mailing Address - Phone:713-594-0179
Mailing Address - Fax:713-513-5655
Practice Address - Street 1:6706 OLD OAKS BLVD
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7140
Practice Address - Country:US
Practice Address - Phone:832-594-4391
Practice Address - Fax:832-594-4391
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX582752163WA0400X, 171000000X, 171M00000X, 374T00000X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX582752OtherREGISTERED NURSE