1811171812 NPI number — MRS. MICHELLE BROOKE HARRIS M.A.

Table of content: MRS. MICHELLE BROOKE HARRIS M.A. (NPI 1811171812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811171812 NPI number — MRS. MICHELLE BROOKE HARRIS M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
MICHELLE
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NEITHINGER
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
BROOKE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FRANKS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811171812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4370 TOWN CENTER BLVD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL DORADO HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95762-7140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-337-8777
Provider Business Mailing Address Fax Number:
916-649-7158

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4370 TOWN CENTER BLVD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95762-7140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-337-8777
Provider Business Practice Location Address Fax Number:
916-649-7158
Provider Enumeration Date:
12/27/2007

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: 106H00000X , with the licence number:  MFC53424 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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