Individual
SHANE HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2250 HICKORY RD, SUITE 240, PLYMOUTH MEETING, PA 19462-1047
(610) 834-1122
Mailing address
10540 171ST ST, JAMAICA, NY 11433-1748
(443) 839-4180
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
331221
NY
164W00000X
Licensed Practical Nurse
LP42394
MD
Other
Enumeration date
05/13/2008
Last updated
02/02/2018
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