Provider Demographics
NPI:1457824252
Name:HARRIS, MARY JANE P (RN, BSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:P
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN, BSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98-1238 KAAHUMANU ST # 403
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3291
Mailing Address - Country:US
Mailing Address - Phone:703-650-5163
Mailing Address - Fax:
Practice Address - Street 1:98-1238 KAAHUMANU ST # 403
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782
Practice Address - Country:US
Practice Address - Phone:703-650-5163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-04
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIAPRN-2574363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily