Provider Demographics
NPI:1467143867
Name:HARRIS, NATASHA NICOLE
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CLAIRISE CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3569
Mailing Address - Country:US
Mailing Address - Phone:504-457-9767
Mailing Address - Fax:
Practice Address - Street 1:1100 CLAIRISE CT
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-3569
Practice Address - Country:US
Practice Address - Phone:504-457-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
00893836171W00000X
LA00893836172A00000X, 342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes342000000XTransportation ServicesTransportation Network Company
No171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty