Provider Demographics
NPI:1780967992
Name:HARRISON, THERESE W (APRN)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:W
Last Name:HARRISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 OLD ORCHARD STREET
Mailing Address - Street 2:ST. CHRISTOPHER'S INC
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595
Mailing Address - Country:US
Mailing Address - Phone:914-949-0665
Mailing Address - Fax:
Practice Address - Street 1:1700 OLD ORCHARD STREET
Practice Address - Street 2:ST. CHRISTOPHER'S INC
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-949-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-23
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3815561363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics