Individual
DETRA DASHAWN HARRISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 E COLTER ST UNIT 285, PHOENIX, AZ 85016-3379
(330) 564-6154
Mailing address
1701 E COLTER ST UNIT 285, PHOENIX, AZ 85016-3379
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
328764
AZ
Other
Enumeration date
12/29/2025
Last updated
12/29/2025
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