Provider Demographics
NPI:1740285337
Name:HARRIS, DEBORAH S (RNC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RNC
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:S
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNC
Mailing Address - Street 1:615 N SEWARD AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-2107
Mailing Address - Country:US
Mailing Address - Phone:315-253-9749
Mailing Address - Fax:315-253-2614
Practice Address - Street 1:615 N SEWARD AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-2107
Practice Address - Country:US
Practice Address - Phone:315-253-9749
Practice Address - Fax:315-253-2614
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421129363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1004760001Medicare NSC
MAHANP2138Medicare PIN
S95270Medicare UPIN
MAHANP2138Medicare ID - Type Unspecified