Provider Demographics
NPI:1144643420
Name:HARRIS, NANCY SUE (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:SUE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 SAN LUCAS AVE
Mailing Address - Street 2:
Mailing Address - City:MOSS BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:94038-9749
Mailing Address - Country:US
Mailing Address - Phone:650-440-9121
Mailing Address - Fax:650-712-8792
Practice Address - Street 1:98 SAN LUCAS AVE
Practice Address - Street 2:
Practice Address - City:MOSS BEACH
Practice Address - State:CA
Practice Address - Zip Code:94038-9749
Practice Address - Country:US
Practice Address - Phone:650-440-9121
Practice Address - Fax:650-712-8792
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine