Provider Demographics
NPI:1164432472
Name:HARRISON, SALLY (CNS)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 STIMSON AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-3207
Mailing Address - Country:US
Mailing Address - Phone:401-465-3362
Mailing Address - Fax:401-331-7575
Practice Address - Street 1:16 STIMSON AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-3207
Practice Address - Country:US
Practice Address - Phone:401-465-3362
Practice Address - Fax:401-331-7575
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPNS00009364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist