Provider Demographics
NPI:1114609385
Name:HARRIS, JAIDEN LORRAIN I
Entity Type:Individual
Prefix:
First Name:JAIDEN
Middle Name:LORRAIN
Last Name:HARRIS
Suffix:I
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 1:80 5TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:OH
Mailing Address - Zip Code:44405-1315
Mailing Address - Country:US
Mailing Address - Phone:330-623-9664
Mailing Address - Fax:
Practice Address - Street 1:80 5TH ST
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:OH
Practice Address - Zip Code:44405-1315
Practice Address - Country:US
Practice Address - Phone:330-623-9664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3654326374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide