Provider Demographics
NPI:1700280112
Name:HARRIS, VERONICA
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:
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 1:3445 BROADWICK ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4890
Mailing Address - Country:US
Mailing Address - Phone:410-493-7065
Mailing Address - Fax:
Practice Address - Street 1:3445 BROADWICK ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4890
Practice Address - Country:US
Practice Address - Phone:410-493-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC172A00000X, 343900000X, 172A00000X
MD15871130172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker