Provider Demographics
NPI:1780432823
Name:HARRIS, DORNESIA SHERLET
Entity type:Individual
Prefix:
First Name:DORNESIA
Middle Name:SHERLET
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 1:906 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202-2332
Mailing Address - Country:US
Mailing Address - Phone:318-547-1560
Mailing Address - Fax:
Practice Address - Street 1:906 S 10TH ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-2332
Practice Address - Country:US
Practice Address - Phone:318-547-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider