Provider Demographics
NPI:1558798066
Name:HARRIS, NATASHA M (LPN)
Entity Type:Individual
Prefix:MS
First Name:NATASHA
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 1:6033 BEAR CREEK DR APT 211
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-2907
Mailing Address - Country:US
Mailing Address - Phone:216-704-4813
Mailing Address - Fax:
Practice Address - Street 1:6033 BEAR CREEK DR APT 211
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-2907
Practice Address - Country:US
Practice Address - Phone:216-704-4813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-28
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151468164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse