Provider Demographics
NPI:1225340763
Name:HARRIS, JUSTIN CURTIS (LPN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:CURTIS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7863 ROUTE 53
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-9524
Mailing Address - Country:US
Mailing Address - Phone:607-794-4774
Mailing Address - Fax:
Practice Address - Street 1:7863 ROUTE 53
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-9524
Practice Address - Country:US
Practice Address - Phone:607-794-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296304164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse