Provider Demographics
NPI:1922579002
Name:HARRIS, CAROLYN (RN)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6215 53RD AVE APT LGC
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1302
Mailing Address - Country:US
Mailing Address - Phone:917-651-6127
Mailing Address - Fax:212-802-1674
Practice Address - Street 1:6215 53RD AVE APT LGC
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1302
Practice Address - Country:US
Practice Address - Phone:917-651-6127
Practice Address - Fax:212-802-1674
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY612436163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool