Provider Demographics
NPI:1144889304
Name:HARRIS, MARQUETA A
Entity type:Individual
Prefix:MS
First Name:MARQUETA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12451
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23541-0451
Mailing Address - Country:US
Mailing Address - Phone:757-776-2653
Mailing Address - Fax:
Practice Address - Street 1:963 ELM ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3220
Practice Address - Country:US
Practice Address - Phone:757-776-2653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide