Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | A01003ANP | AR |
NPI | 1003965120 |
---|---|
Provider Name | Susan A Harris |
First Address | Paragould, AR 72450-7441 |
Second Address | Paragould, AR 72450-9509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
148177758 | (05) | AR |