Provider Demographics
NPI:1053129445
Name:HARRIS, DAMARIE DASHAE
Entity type:Individual
Prefix:MISS
First Name:DAMARIE
Middle Name:DASHAE
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 1:1734 SPRINGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45506-2955
Mailing Address - Country:US
Mailing Address - Phone:937-244-8072
Mailing Address - Fax:
Practice Address - Street 1:1734 SPRINGMONT AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506-2955
Practice Address - Country:US
Practice Address - Phone:937-244-0782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant