Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | RN192280 | GA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN192280 | GA |
NPI | 1063748788 |
---|---|
Provider Name | Mrs. Betty Jean Harris |
First Address | Minnetonka, MN 55343-9664 |
Second Address | Mcdonough, GA 30252-7191 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2009 |
Last Update Date | 22/09/2020 |