Provider Demographics
NPI:1932855111
Name:HARRIS, ROBLEAN
Entity Type:Individual
Prefix:MRS
First Name:ROBLEAN
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 1:915 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-3007
Mailing Address - Country:US
Mailing Address - Phone:318-283-0220
Mailing Address - Fax:318-283-0220
Practice Address - Street 1:915 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3007
Practice Address - Country:US
Practice Address - Phone:318-283-0220
Practice Address - Fax:318-283-0220
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA232581164W00000X
376J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No376J00000XNursing Service Related ProvidersHomemaker