Provider Demographics
NPI:1801302583
Name:HARRIS, LINDSAI (OWNER)
Entity type:Individual
Prefix:
First Name:LINDSAI
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12090 S HARRELLS FERRY RD STE I
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-2470
Mailing Address - Country:US
Mailing Address - Phone:225-369-0963
Mailing Address - Fax:
Practice Address - Street 1:12090 S HARRELLS FERRY RD STE I
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-2470
Practice Address - Country:US
Practice Address - Phone:225-369-0963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA19D2140027291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory