Provider Demographics
NPI:1669876462
Name:HARRIS, KATHLEEN (RN)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
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 1:207 SAFFORD ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-1540
Mailing Address - Country:US
Mailing Address - Phone:617-817-7806
Mailing Address - Fax:
Practice Address - Street 1:251 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4136
Practice Address - Country:US
Practice Address - Phone:978-475-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN199726163W00000X, 163WH0200X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool