Basic Information
| Provider Information | |||||||||
| NPI: | 1790192748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | BOBBIE | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 405 NC HWY 65 | ||||||||
| Address2: | |||||||||
| City: | WENTWORTH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363428316 | ||||||||
| FaxNumber: | 3363428330 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 NC HWY 65 | ||||||||
| Address2: | |||||||||
| City: | WENTWORTH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27375 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3363428316 | ||||||||
| FaxNumber: | 3363428330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2014 | ||||||||
| LastUpdateDate: | 07/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 254770 | NC | Y | Nursing Service Providers | Registered Nurse |
No ID Information.