Provider Demographics
NPI:1386347870
Name:HARRIS, JOANN (MAY 14, 1954)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MAY 14, 1954
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 BRIDGETT STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-6318
Mailing Address - Country:US
Mailing Address - Phone:910-551-8401
Mailing Address - Fax:
Practice Address - Street 1:896 BRIDGETT STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-6318
Practice Address - Country:US
Practice Address - Phone:910-551-8401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC54246164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse