Provider Demographics
NPI:1447075395
Name:HARRIS, HEATHER ELIZABETH (RN/APRN STUDENT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN/APRN STUDENT
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN/APRN STUDENT
Mailing Address - Street 1:823 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-3233
Mailing Address - Country:US
Mailing Address - Phone:203-668-5562
Mailing Address - Fax:
Practice Address - Street 1:2800 MAIN ST FL 4
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4201
Practice Address - Country:US
Practice Address - Phone:475-210-7002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT175029390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program