Provider Demographics
NPI:1275231227
Name:HARRIS, SHANIQUA (CNM, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CNM, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 EBENEZER RD STE 145
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1119
Mailing Address - Country:US
Mailing Address - Phone:803-328-2401
Mailing Address - Fax:
Practice Address - Street 1:1721 EBENEZER RD STE 145
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1119
Practice Address - Country:US
Practice Address - Phone:803-328-2401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC318264163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient