Provider Demographics
NPI:1588683668
Name:HARRIS, SUSANNE MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:SUSANNE
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 373
Mailing Address - Street 2:3204 STATE RTE 52
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12787
Mailing Address - Country:US
Mailing Address - Phone:845-292-1624
Mailing Address - Fax:
Practice Address - Street 1:DAY TOP SWAN LAKE
Practice Address - Street 2:
Practice Address - City:SWAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12783
Practice Address - Country:US
Practice Address - Phone:845-292-6880
Practice Address - Fax:845-292-4873
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5169961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse