Provider Demographics
NPI:1912189713
Name:HARRIS, DOLORES B (RD, LD/N)
Entity type:Individual
Prefix:MRS
First Name:DOLORES
Middle Name:B
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RD, LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 BONITA BAY BLVD
Mailing Address - Street 2:APT 604
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-5665
Mailing Address - Country:US
Mailing Address - Phone:239-949-0377
Mailing Address - Fax:239-949-0748
Practice Address - Street 1:4801 BONITA BAY BLVD
Practice Address - Street 2:APT 604
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-5665
Practice Address - Country:US
Practice Address - Phone:239-949-0377
Practice Address - Fax:239-949-0748
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4702133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered