Provider Demographics
NPI:1811987217
Name:HARRIS, DONNA K (CNP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:K
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 CENTRACARE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303
Mailing Address - Country:US
Mailing Address - Phone:320-229-5000
Mailing Address - Fax:320-229-5184
Practice Address - Street 1:1900 CENTRACARE CIRCLE
Practice Address - Street 2:
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303
Practice Address - Country:US
Practice Address - Phone:320-229-5000
Practice Address - Fax:320-229-5184
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1439175363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
132750OtherU CARE
014106200OtherMEDICAL ASSISTANCE
1652649OtherARAZ GROUP AMERICAS PPO
HP50053OtherHEALTH PARTNERS
0119786OtherMEDICA HEALTH PLANS
1043460OtherPREFERRED ONE
MNR1439175OtherLICENSE NUMBER
496R2HAOtherBLUE CROSS BLUE SHIELD
956S2HAOtherBLUE CROSS BLUE SHIELD
956S2HAOtherBLUE CROSS BLUE SHIELD
1652649OtherARAZ GROUP AMERICAS PPO
MNR1439175OtherLICENSE NUMBER
956S2HAOtherBLUE CROSS BLUE SHIELD
014106200OtherMEDICAL ASSISTANCE
C03065Medicare ID - Type Unspecified