Provider Demographics
NPI:1043459431
Name:HARRIS, LAURIE ANNE (BS RN CDE)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:ANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BS RN CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:600 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1004
Practice Address - Country:US
Practice Address - Phone:518-447-3500
Practice Address - Fax:518-447-3586
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451417163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator