Provider Demographics
NPI:1932422904
Name:HARRIS, DEBRA J (NP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MAPLE ST
Mailing Address - Street 2:P.O. BOX 1268
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-2003
Mailing Address - Country:US
Mailing Address - Phone:217-342-4151
Mailing Address - Fax:217-342-4190
Practice Address - Street 1:300 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:EFFINGHAM
Practice Address - State:IL
Practice Address - Zip Code:62401-2003
Practice Address - Country:US
Practice Address - Phone:217-342-4151
Practice Address - Fax:217-342-4190
Is Sole Proprietor?:No
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008065363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209008065OtherADVANCE PRACTICE NURSE LICENSE
IL37-1329873OtherEMPLOYER (MARSHALL CLINIC EFFINGHAM, S.C.) TAX ID
ILF0210048OtherAM. ACADEMY OF NURSE PRACTITIONERS CERTIFICATION