Provider Demographics
NPI:1497248272
Name:HARRIS, BETTY ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:ANNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5171 S COTTONWOOD ST STE 740
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5705
Mailing Address - Country:US
Mailing Address - Phone:801-507-9700
Mailing Address - Fax:
Practice Address - Street 1:5171 S COTTONWOOD ST STE 740
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5705
Practice Address - Country:US
Practice Address - Phone:801-507-9700
Practice Address - Fax:801-507-9705
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6483798-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care