Provider Demographics
NPI:1134218373
Name:HARRIS, DARLENE MICHELLE (NURSING)
Entity type:Individual
Prefix:MISS
First Name:DARLENE
Middle Name:MICHELLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NURSING
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 GROUPER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306
Mailing Address - Country:US
Mailing Address - Phone:910-425-7394
Mailing Address - Fax:
Practice Address - Street 1:340 GROUPER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-7992
Practice Address - Country:US
Practice Address - Phone:910-425-7394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide