Provider Demographics
NPI:1982253670
Name:HARRIS, CHRISTINE CHARLENE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:CHARLENE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11114 S HARLEM AVE
Mailing Address - Street 2:
Mailing Address - City:WORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60482-3554
Mailing Address - Country:US
Mailing Address - Phone:224-607-4063
Mailing Address - Fax:
Practice Address - Street 1:11200 LINCOLN HWY
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8208
Practice Address - Country:US
Practice Address - Phone:773-968-6253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4008566363LF0000X
OR10047951363LF0000X
IL209019584363LF0000X
WI14092-33363LF0000X
UT14235306-4405363LF0000X
MN10540363LF0000X
NE114637363LF0000X
NDR54645363LF0000X
KS14-159208-011363LF0000X
AR224725363LF0000X
MO2025034368363LF0000X
IAA174959363LF0000X
SDCP002822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily