Provider Demographics
NPI:1184461170
Name:CHILDS-HARRIS, LEXUS
Entity type:Individual
Prefix:
First Name:LEXUS
Middle Name:
Last Name:CHILDS-HARRIS
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 1:380 HITCHCOCK RD UNIT 244
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3900
Mailing Address - Country:US
Mailing Address - Phone:860-514-1505
Mailing Address - Fax:
Practice Address - Street 1:687 STRAITS TPKE STE 2A
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2846
Practice Address - Country:US
Practice Address - Phone:203-709-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104687573363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health