Provider Demographics
NPI:1669035549
Name:HARRIS, ERIC DARMONIQUE
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DARMONIQUE
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 GEFFERT DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-3924
Mailing Address - Country:US
Mailing Address - Phone:804-309-5281
Mailing Address - Fax:
Practice Address - Street 1:1801 GEFFERT DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-3924
Practice Address - Country:US
Practice Address - Phone:804-309-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA14545372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty