Provider Demographics
NPI:1043752736
Name:HARRIS, FAITH (LPN)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:
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 1:3401 ROYAL AVE
Mailing Address - Street 2:3401 ROYAL AVE
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-2115
Mailing Address - Country:US
Mailing Address - Phone:716-578-2664
Mailing Address - Fax:
Practice Address - Street 1:3401 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14303-2115
Practice Address - Country:US
Practice Address - Phone:716-578-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-11
Last Update Date:2016-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274699-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse