Organization
REGINNA HARRIS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GRETCHEN TYSON (CREDENTIALING SPECIALIST)
(740) 450-6147
Entity
Organization
Contact information
Practice address
1246 ASHLAND AVE, ZANESVILLE, OH 43701-2861
(740) 455-4923
Mailing address
5720 FOXFIRE DR, ZANESVILLE, OH 43701-8136
(740) 607-3478
Taxonomy
Speciality
Code
Description
License number
State
261QP0904X
Federal Public Health Clinic/Center
Primary
COA19004-NP
OH
Other
Enumeration date
05/10/2016
Last updated
05/16/2016
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