Provider Demographics
NPI:1104586999
Name:HARRISON, MARK DANIEL (RN, BSN)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DANIEL
Last Name:HARRISON
Suffix:
Gender:M
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 S ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-5918
Mailing Address - Country:US
Mailing Address - Phone:717-648-7663
Mailing Address - Fax:
Practice Address - Street 1:1721 S ALLEN ST
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-5918
Practice Address - Country:US
Practice Address - Phone:717-648-7663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN331136L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PARN331136LOtherBOARD OF NURSING