Provider Demographics
NPI:1407160286
Name:HARRIS, JAY EDWARD (RN, MSN)
Entity Type:Individual
Prefix:MR
First Name:JAY
Middle Name:EDWARD
Last Name:HARRIS
Suffix:
Gender:M
Credentials:RN, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 NE 12TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4412
Mailing Address - Country:US
Mailing Address - Phone:541-530-3066
Mailing Address - Fax:
Practice Address - Street 1:1058 NE 12TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4412
Practice Address - Country:US
Practice Address - Phone:541-530-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200341738163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200341738OtherOREGON NURSING LICENSE