Provider Demographics
NPI:1083481774
Name:HARRIS, BAMBI
Entity Type:Individual
Prefix:
First Name:BAMBI
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 HOLCOMB HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:THURMAN
Mailing Address - State:OH
Mailing Address - Zip Code:45685-9315
Mailing Address - Country:US
Mailing Address - Phone:740-208-7163
Mailing Address - Fax:
Practice Address - Street 1:553 HOLCOMB HOLLOW RD
Practice Address - Street 2:
Practice Address - City:THURMAN
Practice Address - State:OH
Practice Address - Zip Code:45685-9315
Practice Address - Country:US
Practice Address - Phone:740-208-7163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant