Provider Demographics
NPI:1184234841
Name:HARRIS, KAREN YVONNE (LPN)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:YVONNE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HARVARD ST APT 16
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1405
Mailing Address - Country:US
Mailing Address - Phone:617-970-4690
Mailing Address - Fax:
Practice Address - Street 1:1000 HARVARD ST APT 16
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02126-1405
Practice Address - Country:US
Practice Address - Phone:617-970-4690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN53455208000000X, 164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No208000000XAllopathic & Osteopathic PhysiciansPediatrics