Individual
CLARICE HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
190 EGBERT AVE, STATEN ISLAND, NY 10310-2622
(212) 470-3160
Mailing address
190 EGBERT AVE, STATEN ISLAND, NY 10310-2622
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0200204
NY
Other
Enumeration date
07/10/2018
Last updated
07/10/2018
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