Provider Demographics
NPI:1174766612
Name:HARRISON, CAROL ELLEN (RN)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ELLEN
Last Name:HARRISON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1427
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-1427
Mailing Address - Country:US
Mailing Address - Phone:775-846-2896
Mailing Address - Fax:
Practice Address - Street 1:1700 BUCKTHORN CT
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4127
Practice Address - Country:US
Practice Address - Phone:775-846-2896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN10911322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children