Provider Demographics
NPI:1568562148
Name:HARRIS, TERYL YVONNE (LVN)
Entity Type:Individual
Prefix:
First Name:TERYL
Middle Name:YVONNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 MOR DELL RD
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-5472
Mailing Address - Country:US
Mailing Address - Phone:530-872-3852
Mailing Address - Fax:
Practice Address - Street 1:1530 MOR DELL RD
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-5472
Practice Address - Country:US
Practice Address - Phone:530-872-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN181042164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse