Provider Demographics
NPI:1528662855
Name:HARRIS, LINDA (CNA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 RIPLEY RD
Mailing Address - Street 2:
Mailing Address - City:REEDY
Mailing Address - State:WV
Mailing Address - Zip Code:25270-9524
Mailing Address - Country:US
Mailing Address - Phone:304-965-4594
Mailing Address - Fax:
Practice Address - Street 1:5122 RIPLEY RD
Practice Address - Street 2:
Practice Address - City:REEDY
Practice Address - State:WV
Practice Address - Zip Code:25270-9524
Practice Address - Country:US
Practice Address - Phone:304-965-4594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant