Provider Demographics
NPI:1154883254
Name:HARRIS, DORTHEA ALEASE
Entity type:Individual
Prefix:
First Name:DORTHEA
Middle Name:ALEASE
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 1:558 MALCOLM X AVE SE APT 2
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-2591
Mailing Address - Country:US
Mailing Address - Phone:202-423-4861
Mailing Address - Fax:
Practice Address - Street 1:3298 FORT LINCOLN DR NE APT 1010
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4342
Practice Address - Country:US
Practice Address - Phone:202-709-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant