Provider Demographics
NPI:1689117525
Name:HARRIS, JONATHAN (APRN)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BELMONT AVE
Mailing Address - Street 2:GANNET BUILDING 2ND FLOOR
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-7110
Mailing Address - Country:US
Mailing Address - Phone:802-251-8787
Mailing Address - Fax:802-251-8778
Practice Address - Street 1:21 BELMONT AVE
Practice Address - Street 2:GANNET BUILDING 2ND FLOOR
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-7110
Practice Address - Country:US
Practice Address - Phone:802-251-8787
Practice Address - Fax:802-251-8778
Is Sole Proprietor?:No
Enumeration Date:2016-11-26
Last Update Date:2016-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0125563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily