Provider Demographics
NPI:1427182252
Name:HARRIS, MARJORIE ANITA (RN)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANITA
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 1:20170 CAROL ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-1655
Mailing Address - Country:US
Mailing Address - Phone:313-864-8978
Mailing Address - Fax:313-852-4468
Practice Address - Street 1:14585 GREENFIELD ROAD
Practice Address - Street 2:DETROIT HEALTH DEPT. - GRACE ROSS HEALTH CENTER
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48227
Practice Address - Country:US
Practice Address - Phone:313-852-4565
Practice Address - Fax:313-852-4468
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704119140163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator