Provider Demographics
NPI:1457626707
Name:HARRIS, ALTHEA JACQUELINE (LPN)
Entity Type:Individual
Prefix:MS
First Name:ALTHEA
Middle Name:JACQUELINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 BRONX AVE
Mailing Address - Street 2:2ND. FL
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-4604
Mailing Address - Country:US
Mailing Address - Phone:203-685-6093
Mailing Address - Fax:203-612-1852
Practice Address - Street 1:87 BRONX AVE
Practice Address - Street 2:2ND. FL
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4604
Practice Address - Country:US
Practice Address - Phone:203-685-6093
Practice Address - Fax:203-612-1852
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292335-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse