Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 5011813 | NC |
NPI | 1013571561 |
---|---|
Provider Name | Joseph Patrick Harris |
First Address | Winston Salem, NC 27101-5808 |
Second Address | Winston Salem, NC 27104-3556 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2019 |
Last Update Date | 27/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
259677 | RN LICENSE # (01) | |
5011813 | NP LICENSE # (01) | NC |