Provider Demographics
NPI:1821774670
Name:HARRISON, LANA LEIGH
Entity Type:Individual
Prefix:
First Name:LANA
Middle Name:LEIGH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 TIFFANY TRL
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-8322
Mailing Address - Country:US
Mailing Address - Phone:979-255-6939
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT MARKS PL STE 160
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-1253
Practice Address - Country:US
Practice Address - Phone:979-242-5677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604480163W00000X
TX1129217363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse