Provider Demographics
NPI:1043793003
Name:HARRIS, DONNA JENE (L AC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JENE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1634
Mailing Address - Country:US
Mailing Address - Phone:541-441-4138
Mailing Address - Fax:541-295-8235
Practice Address - Street 1:845 NE 7TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1634
Practice Address - Country:US
Practice Address - Phone:541-295-8121
Practice Address - Fax:541-295-8235
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2020-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC189495171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist