Provider Demographics
NPI:1801145776
Name:HARRIS, ANDREA L (ARNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ARNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-3204
Mailing Address - Country:US
Mailing Address - Phone:712-258-4578
Mailing Address - Fax:712-258-1061
Practice Address - Street 1:800 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1317
Practice Address - Country:US
Practice Address - Phone:712-234-2300
Practice Address - Fax:712-234-2398
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-103867363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA-103867OtherSTATE LICENSE