Provider Demographics
NPI:1710299326
Name:HARRIS, CARLA RENEE' (LVN)
Entity Type:Individual
Prefix:MISS
First Name:CARLA
Middle Name:RENEE'
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6817 MILL SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-3223
Mailing Address - Country:US
Mailing Address - Phone:209-688-7699
Mailing Address - Fax:
Practice Address - Street 1:6817 MILL SPRINGS CT
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-3223
Practice Address - Country:US
Practice Address - Phone:209-688-7699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 204582164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse