1811987217 NPI number — DONNA K HARRIS CNP

Table of content: DONNA K HARRIS CNP (NPI 1811987217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811987217 NPI number — DONNA K HARRIS CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
DONNA
Provider Middle Name:
K
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811987217
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 CENTRACARE CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST CLOUD
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-229-5000
Provider Business Mailing Address Fax Number:
320-229-5184

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 CENTRACARE CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST CLOUD
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-229-5000
Provider Business Practice Location Address Fax Number:
320-229-5184
Provider Enumeration Date:
10/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R1439175 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 132750 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 014106200 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1652649 . This is a "ARAZ GROUP AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: HP50053 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0119786 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1043460 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: R1439175 . This is a "LICENSE NUMBER" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 496R2HA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 956S2HA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".