Provider Demographics
NPI:1255585485
Name:HARRIS, BEVERLY (NP)
Entity type:Individual
Prefix:
First Name:BEVERLY
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 1:100 BOSTON RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1879
Mailing Address - Country:US
Mailing Address - Phone:978-448-4300
Mailing Address - Fax:978-448-4040
Practice Address - Street 1:100 BOSTON RD
Practice Address - Street 2:SUITE E
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1879
Practice Address - Country:US
Practice Address - Phone:978-448-4300
Practice Address - Fax:978-448-4040
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232915363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health