Provider Demographics
NPI:1629599212
Name:HARRIS, LEANNA MAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LEANNA
Middle Name:MAE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7047 BONNIE BRAE LN
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3131
Mailing Address - Country:US
Mailing Address - Phone:360-921-0345
Mailing Address - Fax:
Practice Address - Street 1:7047 BONNIE BRAE LN
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80922-3131
Practice Address - Country:US
Practice Address - Phone:360-921-0345
Practice Address - Fax:360-921-0345
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1647982163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse