Provider Demographics
NPI:1821838103
Name:HARRIS, NKECHI STELLAMARIS
Entity type:Individual
Prefix:
First Name:NKECHI
Middle Name:STELLAMARIS
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 25914
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-0914
Mailing Address - Country:US
Mailing Address - Phone:763-318-3635
Mailing Address - Fax:651-461-9264
Practice Address - Street 1:6812 BUCKINGHAM CT
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2401
Practice Address - Country:US
Practice Address - Phone:763-318-3635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-25
Last Update Date:2024-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2498182163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty