Provider Demographics
NPI:1144571787
Name:HARRISON, CAROLINA WAKINA
Entity Type:Individual
Prefix:MISS
First Name:CAROLINA
Middle Name:WAKINA
Last Name:HARRISON
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 1:2857 FREDDIE ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71107-4215
Mailing Address - Country:US
Mailing Address - Phone:318-518-2811
Mailing Address - Fax:
Practice Address - Street 1:2857 FREDDIE ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71107-4215
Practice Address - Country:US
Practice Address - Phone:318-518-2811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-22
Last Update Date:2012-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA009004761343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)