Provider Demographics
NPI:1689636383
Name:HARRIS, SUZANNE MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 LANDMARK DR
Mailing Address - Street 2:128
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4983
Mailing Address - Country:US
Mailing Address - Phone:410-590-4141
Mailing Address - Fax:
Practice Address - Street 1:808 LANDMARK DR
Practice Address - Street 2:128
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4983
Practice Address - Country:US
Practice Address - Phone:410-590-4141
Practice Address - Fax:410-590-4159
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR054252363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health