Provider Demographics
NPI:1114398252
Name:HARRIS, LUCA SMITH (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:LUCA
Middle Name:SMITH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:SMITH
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP
Mailing Address - Street 1:3550 N INTERSTATE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1196
Mailing Address - Country:US
Mailing Address - Phone:503-285-9321
Mailing Address - Fax:
Practice Address - Street 1:108 CENTRE ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2550
Practice Address - Country:US
Practice Address - Phone:207-386-1800
Practice Address - Fax:207-517-6915
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201704243NP-PP363LF0000X
MECNP151047363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily