Provider Demographics
NPI:1184083974
Name:HARRIS, ROCHELLE (NP)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27267 LEHIGH ST
Mailing Address - Street 2:
Mailing Address - City:INKSTER
Mailing Address - State:MI
Mailing Address - Zip Code:48141-3173
Mailing Address - Country:US
Mailing Address - Phone:313-492-5243
Mailing Address - Fax:
Practice Address - Street 1:27267 LEHIGH ST
Practice Address - Street 2:
Practice Address - City:INKSTER
Practice Address - State:MI
Practice Address - Zip Code:48141-3173
Practice Address - Country:US
Practice Address - Phone:313-492-5243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF0116541363LF0000X
MI4704235620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily