Provider Demographics
NPI:1558034017
Name:HARRIS, ELAINE MAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MAE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:MAE
Other - Last Name:GEMPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:803 HONEYSUCKLE DR
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-1388
Mailing Address - Country:US
Mailing Address - Phone:765-212-5770
Mailing Address - Fax:
Practice Address - Street 1:1000 1ST ST N
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-8703
Practice Address - Country:US
Practice Address - Phone:205-620-8100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-29
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-167427163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse