Individual
MR. JAY EDWARD HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN, MSN
Contact information
Practice address
1058 NE 12TH ST, BEND, OR 97701-4412
(541) 530-3066
Mailing address
1058 NE 12TH ST, BEND, OR 97701-4412
(541) 530-3066
Taxonomy
Speciality
Code
Description
License number
State
163WA2000X
Administrator Registered Nurse
Primary
200341738
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200341738
OREGON NURSING LICENSE
OR
Enumeration date
08/03/2010
Last updated
08/03/2010
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