Provider Demographics
NPI:1750765178
Name:HARRIS, SHIRLEY
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name: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:PO BOX 411
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:MO
Mailing Address - Zip Code:63870-0411
Mailing Address - Country:US
Mailing Address - Phone:888-540-0786
Mailing Address - Fax:
Practice Address - Street 1:511 S. DIXIE STREET
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:MO
Practice Address - Zip Code:63870-0411
Practice Address - Country:US
Practice Address - Phone:888-540-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-15
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver