Provider Demographics
NPI:1922429083
Name:HARRIS, MARQUITA (LVN)
Entity Type:Individual
Prefix:
First Name:MARQUITA
Middle Name:
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 1:2403 SEASONS RD
Mailing Address - Street 2:APT # 3306
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76014-4609
Mailing Address - Country:US
Mailing Address - Phone:817-300-5269
Mailing Address - Fax:
Practice Address - Street 1:2403 SEASONS RD
Practice Address - Street 2:APT # 3306
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76014-4609
Practice Address - Country:US
Practice Address - Phone:817-300-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX306939164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse