Individual
MRS. DOROTHY HARRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
615 NORTH GRAND, SAINT LOUIS, MO 63103
(314) 652-4100
Mailing address
615 N GRAND BLVD, SAINT LOUIS, MO 63103-1008
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
037200
MO
Other
Enumeration date
06/21/2012
Last updated
06/21/2012
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