Provider Demographics
NPI:1518201839
Name:HARRIS, CARMELLA G (LPN)
Entity Type:Individual
Prefix:
First Name:CARMELLA
Middle Name:G
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CARMELLA
Other - Middle Name:G
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:360 DELEWARE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1620
Mailing Address - Country:US
Mailing Address - Phone:716-852-5900
Mailing Address - Fax:716-852-5913
Practice Address - Street 1:360 DELEWARE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1620
Practice Address - Country:US
Practice Address - Phone:716-852-5900
Practice Address - Fax:716-852-5913
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212791164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse