Healthcare Provider Details

I. General information

NPI: 1902340417
Provider Name (Legal Business Name): KATIE E HARRIS CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATIE E EPTING CNM, WHNP

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 ACTON ST
BERKELEY CA
94702-2709
US

IV. Provider business mailing address

3104 ACTON ST
BERKELEY CA
94702-2709
US

V. Phone/Fax

Practice location:
  • Phone: 202-658-8610
  • Fax:
Mailing address:
  • Phone: 202-658-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberNMW235828
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP95005533
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number235828
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: