Provider Demographics
NPI:1992177018
Name:HARRIS, VONICE ARLENE
Entity type:Individual
Prefix:MRS
First Name:VONICE
Middle Name:ARLENE
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 1:5500 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3042
Mailing Address - Country:US
Mailing Address - Phone:512-801-5968
Mailing Address - Fax:512-358-4481
Practice Address - Street 1:5500 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3042
Practice Address - Country:US
Practice Address - Phone:512-801-5968
Practice Address - Fax:512-358-4481
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor