Provider Demographics
NPI:1457875551
Name:HARRIS, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
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 1:1017 E. BASIN AVE
Mailing Address - Street 2:#3
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89060
Mailing Address - Country:US
Mailing Address - Phone:775-440-6876
Mailing Address - Fax:
Practice Address - Street 1:1017 E BASIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89060-4532
Practice Address - Country:US
Practice Address - Phone:775-751-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-31
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker