Provider Demographics
NPI:1518681881
Name:HARRIS, JINA M (LPN)
Entity Type:Individual
Prefix:
First Name:JINA
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 CONGRESS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-4566
Mailing Address - Country:US
Mailing Address - Phone:518-203-8191
Mailing Address - Fax:
Practice Address - Street 1:168 CONGRESS ST APT 2
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-4566
Practice Address - Country:US
Practice Address - Phone:518-203-8191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310266164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse