Provider Demographics
NPI:1194473702
Name:HARRIS, BLANCHE NOELLE
Entity Type:Individual
Prefix:
First Name:BLANCHE
Middle Name:NOELLE
Last Name:HARRIS
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 1:2265 NC HIGHWAY 24 27 E
Mailing Address - Street 2:
Mailing Address - City:BISCOE
Mailing Address - State:NC
Mailing Address - Zip Code:27209-9758
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2265 NC HIGHWAY 24 27 E
Practice Address - Street 2:
Practice Address - City:BISCOE
Practice Address - State:NC
Practice Address - Zip Code:27209-9758
Practice Address - Country:US
Practice Address - Phone:843-594-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-13
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCF10210470207Q00000X
NC5016009363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine