Provider Demographics
NPI:1194021618
Name:HARRISON, GERALD DEAN III (LVN)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:DEAN
Last Name:HARRISON
Suffix:III
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:JR
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LVN
Mailing Address - Street 1:1101 UNION AVE # 100
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93307-1050
Mailing Address - Country:US
Mailing Address - Phone:661-631-1483
Mailing Address - Fax:661-631-8665
Practice Address - Street 1:1101 UNION AVE # 100
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-1050
Practice Address - Country:US
Practice Address - Phone:661-631-1483
Practice Address - Fax:661-631-8665
Is Sole Proprietor?:No
Enumeration Date:2011-01-31
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA242649164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse