Provider Demographics
NPI:1720786254
Name:LEE-HARRIS, LIANA
Entity Type:Individual
Prefix:MRS
First Name:LIANA
Middle Name:
Last Name:LEE-HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W CENTER ST APT C4
Mailing Address - Street 2:
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1642
Mailing Address - Country:US
Mailing Address - Phone:603-498-9478
Mailing Address - Fax:
Practice Address - Street 1:401 W CENTER ST APT C4
Practice Address - Street 2:
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1642
Practice Address - Country:US
Practice Address - Phone:603-498-9478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2260518163W00000X
MARN2250618363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse