Provider Demographics
NPI:1932528627
Name:HARRIS, CHAKIRA
Entity Type:Individual
Prefix:
First Name:CHAKIRA
Middle Name:
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 1:943 WEST LAFAYETTE AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207
Mailing Address - Country:US
Mailing Address - Phone:315-254-9777
Mailing Address - Fax:
Practice Address - Street 1:943 WEST LAFAYETTE AVE
Practice Address - Street 2:APT 2
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207
Practice Address - Country:US
Practice Address - Phone:315-254-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY316916-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse