Provider Demographics
NPI:1366825341
Name:HARRIS, PEI J (DNP, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:PEI
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SCOTT LN
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97459-2464
Mailing Address - Country:US
Mailing Address - Phone:541-283-5662
Mailing Address - Fax:
Practice Address - Street 1:1430 SCOTT LN
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:OR
Practice Address - Zip Code:97459-2464
Practice Address - Country:US
Practice Address - Phone:541-283-5662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004465363LF0000X
OR201600346NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500701053Medicaid