Provider Demographics
NPI:1447870878
Name:HARRISON, GINA MARIE (CRNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CRNP, PMHNP-BC
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:MARIE
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN
Mailing Address - Street 1:PO BOX 1388
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-0379
Mailing Address - Country:US
Mailing Address - Phone:570-288-8881
Mailing Address - Fax:570-288-8065
Practice Address - Street 1:360 WHITE DEER RUN RD
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:PA
Practice Address - Zip Code:17810-9268
Practice Address - Country:US
Practice Address - Phone:570-428-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-27
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021761363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health