Provider Demographics
NPI:1659494581
Name:HARRIS, DELORES ELENE JOY (RN)
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:ELENE JOY
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 1:11412 GRAY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-2323
Mailing Address - Country:US
Mailing Address - Phone:216-541-5446
Mailing Address - Fax:216-541-5446
Practice Address - Street 1:11412 GRAY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-2323
Practice Address - Country:US
Practice Address - Phone:216-541-5446
Practice Address - Fax:216-541-5446
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH324449163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2674842Medicaid