Provider Demographics
NPI:1962216416
Name:HARRIS, DEONTE TERRELL SR
Entity type:Individual
Prefix:
First Name:DEONTE
Middle Name:TERRELL
Last Name:HARRIS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3202 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-4042
Mailing Address - Country:US
Mailing Address - Phone:402-320-3376
Mailing Address - Fax:
Practice Address - Street 1:3202 MADISON ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-4042
Practice Address - Country:US
Practice Address - Phone:402-320-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide