Provider Demographics
NPI:1487992244
Name:HARRIS, MELISSA SUE (RN)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:SUE
Last Name:HARRIS
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 1:6962 STATE ROUTE 41
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-8726
Mailing Address - Country:US
Mailing Address - Phone:607-299-4468
Mailing Address - Fax:
Practice Address - Street 1:6962 STATE ROUTE 41
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-8726
Practice Address - Country:US
Practice Address - Phone:607-299-4468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY582719163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse