Provider Demographics
NPI:1881052967
Name:HARRISON, ADELE A (APRN)
Entity type:Individual
Prefix:
First Name:ADELE
Middle Name:A
Last Name:HARRISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ADELE
Other - Middle Name:A
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:111 S 90TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3907
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S 90TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3907
Practice Address - Country:US
Practice Address - Phone:402-397-9800
Practice Address - Fax:402-397-7591
Is Sole Proprietor?:No
Enumeration Date:2016-02-04
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111963363L00000X
NE11963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner