Provider Demographics
NPI:1225211311
Name:HARRIS, JESSICA NICOLE (RN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:NICOLE
Other - Last Name:WAYMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1001 BELMONT AVE UNIT 306
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-5965
Mailing Address - Country:US
Mailing Address - Phone:310-371-0813
Mailing Address - Fax:310-371-6851
Practice Address - Street 1:19601 MARINER AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1647
Practice Address - Country:US
Practice Address - Phone:310-371-0813
Practice Address - Fax:310-371-6851
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA660510163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator