Provider Demographics
NPI:1457928293
Name:HARRIS, ERIN (LPN, MDS)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8405 CLEARVISTA PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3737
Mailing Address - Country:US
Mailing Address - Phone:317-578-7500
Mailing Address - Fax:317-578-7533
Practice Address - Street 1:8405 CLEARVISTA PL
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3737
Practice Address - Country:US
Practice Address - Phone:317-578-7500
Practice Address - Fax:317-578-7533
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27071419A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse