Basic Information
| Provider Information | |||||||||
| NPI: | 1194388926 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | HAROLD | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3240 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077968498 | ||||||||
| FaxNumber: | 9077968497 | ||||||||
| Practice Location | |||||||||
| Address1: | 3240 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | JUNEAU | ||||||||
| State: | AK | ||||||||
| PostalCode: | 998017808 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9077968498 | ||||||||
| FaxNumber: | 9077968497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | NURP7208 | AK | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.