Provider Demographics
NPI:1669662565
Name:HARRIS, VICKI S (RN)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8291 N 40TH ST E
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-8132
Mailing Address - Country:US
Mailing Address - Phone:918-441-8311
Mailing Address - Fax:
Practice Address - Street 1:8291 N 40TH ST E
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-8132
Practice Address - Country:US
Practice Address - Phone:918-441-8311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0071742163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse