Provider Demographics
NPI:1578003455
Name:HARRISON, DORETHA
Entity Type:Individual
Prefix:
First Name:DORETHA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 GEORGIA AVE NW
Mailing Address - Street 2:APT 419
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-3084
Mailing Address - Country:US
Mailing Address - Phone:202-246-3405
Mailing Address - Fax:
Practice Address - Street 1:3232 GEORGIA AVE NW
Practice Address - Street 2:APT 419
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3084
Practice Address - Country:US
Practice Address - Phone:202-246-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide