Provider Demographics
NPI:1164792214
Name:HARRIS, HEATHER JILL (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JILL
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 EASTMONT CT
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4432
Mailing Address - Country:US
Mailing Address - Phone:937-597-8289
Mailing Address - Fax:
Practice Address - Street 1:2510 EASTMONT CT
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-4432
Practice Address - Country:US
Practice Address - Phone:937-597-8289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD-0891133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered