Provider Demographics
NPI:1447959242
Name:HARRIS, REBECCA (CNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W MCCREIGHT AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-1853
Mailing Address - Country:US
Mailing Address - Phone:937-523-8837
Mailing Address - Fax:513-362-7876
Practice Address - Street 1:30 W MCCREIGHT AVE STE 208
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-1853
Practice Address - Country:US
Practice Address - Phone:937-523-8837
Practice Address - Fax:513-362-7876
Is Sole Proprietor?:No
Enumeration Date:2023-03-01
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRNCNP0033382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F02231136OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
OHAPRN.CNP.0033382OtherOHIO BOARD OF NURSING