Provider Demographics
NPI:1912604570
Name:HARRIS, ELISHA EVETTE (RN)
Entity type:Individual
Prefix:
First Name:ELISHA
Middle Name:EVETTE
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 1:221 DILLON CIR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1063
Mailing Address - Country:US
Mailing Address - Phone:864-590-8039
Mailing Address - Fax:
Practice Address - Street 1:221 DILLON CIR
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1063
Practice Address - Country:US
Practice Address - Phone:864-590-8039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC234382163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse