Provider Demographics
NPI:1073888145
Name:HARRIS, DAN E (CRNP)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 LAKESHORE DR
Mailing Address - Street 2:SUITE 440
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6729
Mailing Address - Country:US
Mailing Address - Phone:205-874-7844
Mailing Address - Fax:
Practice Address - Street 1:2204 LAKESHORE DR
Practice Address - Street 2:SUITE 440
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6729
Practice Address - Country:US
Practice Address - Phone:205-802-1094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-044722363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health