Provider Demographics
NPI:1437985660
Name:HARRISON, TELA RENEE (CCMA, CD(DONA))
Entity type:Individual
Prefix:
First Name:TELA
Middle Name:RENEE
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CCMA, CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3723 SE 42ND AVE APT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-3285
Mailing Address - Country:US
Mailing Address - Phone:808-348-1734
Mailing Address - Fax:
Practice Address - Street 1:3723 SE 42ND AVE APT B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-3285
Practice Address - Country:US
Practice Address - Phone:808-348-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula