Provider Demographics
NPI:1164205837
Name:HARRIS, MARY E (APRN, CNM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7803 HOLMES RUN DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-3320
Mailing Address - Country:US
Mailing Address - Phone:703-598-4756
Mailing Address - Fax:
Practice Address - Street 1:14701 ROUTE 29 STE 303
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2135
Practice Address - Country:US
Practice Address - Phone:703-830-4388
Practice Address - Fax:703-830-4188
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024187850367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife