Provider Demographics
NPI:1285877829
Name:HARRISON, TIMOTHY (LPN)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MAGNOLIA CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-5211
Mailing Address - Country:US
Mailing Address - Phone:845-473-5900
Mailing Address - Fax:845-473-6692
Practice Address - Street 1:101 MAGNOLIA CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-5211
Practice Address - Country:US
Practice Address - Phone:845-473-5900
Practice Address - Fax:845-473-6692
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219866164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse