Provider Demographics
NPI:1629476189
Name:HARRIS, KRISTINE (NP)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 WATER ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-2648
Mailing Address - Country:US
Mailing Address - Phone:978-685-2460
Mailing Address - Fax:978-685-2572
Practice Address - Street 1:120 WATER ST
Practice Address - Street 2:SUITE 404
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-2648
Practice Address - Country:US
Practice Address - Phone:978-685-2460
Practice Address - Fax:978-685-2572
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211982163W00000X
MARN211982364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse