Provider Demographics
NPI:1518224963
Name:HARRIS, EDWARD
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 BLOOMFIELD DR
Mailing Address - Street 2:APT L
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426
Mailing Address - Country:US
Mailing Address - Phone:937-674-7011
Mailing Address - Fax:
Practice Address - Street 1:4921 BLOOMFIELD DR
Practice Address - Street 2:APT L
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426
Practice Address - Country:US
Practice Address - Phone:937-674-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide