Provider Demographics
NPI:1861868408
Name:HARRIS, REBECCA (CRNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 MONTVIEU CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-2648
Mailing Address - Country:US
Mailing Address - Phone:410-917-8009
Mailing Address - Fax:410-666-9898
Practice Address - Street 1:49 MONTVIEU CT
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-2648
Practice Address - Country:US
Practice Address - Phone:410-917-8009
Practice Address - Fax:410-666-9898
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194442363LP0222X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care