Provider Demographics
NPI:1235134883
Name:HARRIS, LUANN (NP)
Entity Type:Individual
Prefix:
First Name:LUANN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:3 BUTTERNUT DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4653
Practice Address - Country:US
Practice Address - Phone:864-241-7272
Practice Address - Fax:864-672-7852
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC947363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0245Medicaid
SCP01148273OtherRAILROAD MEDICARE
SC6526Medicare PIN
SCS66278Medicare UPIN
SCNP0245Medicaid