Provider Demographics
NPI:1326793365
Name:MCINTOSH-HARRISON, ERICA (RN)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:MCINTOSH-HARRISON
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 1:3310 FOUNTAIN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-6777
Mailing Address - Country:US
Mailing Address - Phone:219-707-9419
Mailing Address - Fax:
Practice Address - Street 1:3310 FOUNTAIN HILLS DR
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-6777
Practice Address - Country:US
Practice Address - Phone:219-707-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX848287163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse