Provider Demographics
NPI:1841942224
Name:HARRIS, TEONNA
Entity type:Individual
Prefix:
First Name:TEONNA
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 1:1502 SUMMIT OAK CT APT A
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-6236
Mailing Address - Country:US
Mailing Address - Phone:269-830-5751
Mailing Address - Fax:
Practice Address - Street 1:1502 SUMMIT OAK CT APT A
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-6236
Practice Address - Country:US
Practice Address - Phone:269-830-5751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401199576376K00000X
MI2837246247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty