Provider Demographics
NPI:1649587932
Name:HARRIS, PATRICIA ANN (CERTIFIED NURSE ASSI)
Entity Type:Individual
Prefix:MISS
First Name:PATRICIA
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CERTIFIED NURSE ASSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 SO 3RD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48607
Mailing Address - Country:US
Mailing Address - Phone:989-755-1936
Mailing Address - Fax:
Practice Address - Street 1:1520 EAST GENNESSEE
Practice Address - Street 2:
Practice Address - City:SSAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-755-1936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI#09-00004010372500000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No372500000XNursing Service Related ProvidersChore Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI96-231-1119OtherDUNS.