Provider Demographics
NPI:1760690895
Name:HARRIS-WILSON, LENA E (RD, LD)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:E
Last Name:HARRIS-WILSON
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3306 WENDOVER CT
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-3248
Mailing Address - Country:US
Mailing Address - Phone:972-238-0904
Mailing Address - Fax:469-633-6991
Practice Address - Street 1:1600 COIT RD
Practice Address - Street 2:SUITE # 107
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6174
Practice Address - Country:US
Practice Address - Phone:972-867-9507
Practice Address - Fax:972-867-9527
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80232133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered