Basic Information
| Provider Information | |||||||||
| NPI: | 1285877829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRISON | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MAGNOLIA CT | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND MILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109305211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454735900 | ||||||||
| FaxNumber: | 8454736692 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MAGNOLIA CT | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND MILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109305211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8454735900 | ||||||||
| FaxNumber: | 8454736692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 04/13/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 219866 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.