Provider Demographics
NPI:1306008644
Name:HARRIS, JENNIFER DENISE (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DENISE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 SE 28TH STREET TERRACE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66605-1817
Mailing Address - Country:US
Mailing Address - Phone:785-266-3461
Mailing Address - Fax:785-266-3461
Practice Address - Street 1:3007 SE 28TH STREET TERRACE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-1817
Practice Address - Country:US
Practice Address - Phone:785-266-3461
Practice Address - Fax:785-266-3461
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-46991-032171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator