Provider Demographics
NPI:1386020576
Name:HARRIS, LORNE (NP)
Entity type:Individual
Prefix:
First Name:LORNE
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-600-4900
Mailing Address - Fax:415-369-1314
Practice Address - Street 1:45 CASTRO ST STE 402
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-1040
Practice Address - Country:US
Practice Address - Phone:415-600-4900
Practice Address - Fax:415-369-1314
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95005551363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN95105522OtherSTATE MEDICAL LICENSE
CANP95005551OtherSTATE MEDICAL LICENSE
CANPF95005551OtherSTATE MEDICAL LICENSE