Provider Demographics
NPI:1265268809
Name:HARRIS, NINA MARIE
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 MAIN ST STE 211
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-5425
Mailing Address - Country:US
Mailing Address - Phone:501-238-1261
Mailing Address - Fax:501-307-3696
Practice Address - Street 1:1023 MAIN ST STE 211
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-5425
Practice Address - Country:US
Practice Address - Phone:501-238-1261
Practice Address - Fax:501-307-3696
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies