Basic Information
| Provider Information | |||||||||
| NPI: | 1659810984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | MARLA | ||||||||
| MiddleName: | SARA | ||||||||
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| OtherLastName: | HARRIS | ||||||||
| OtherFirstName: | MARLA | ||||||||
| OtherMiddleName: | SARA | ||||||||
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| OtherCredential: | RN | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 603 N WILMOT RD # 201 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857112701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207901556 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 603 N WILMOT RD # 201 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857112701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207901556 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2017 | ||||||||
| LastUpdateDate: | 03/23/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP10243 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.