Healthcare Provider Details

I. General information

NPI: 1730456682
Provider Name (Legal Business Name): EMILY HARRIS-DEUTCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 NE GREENWOOD AVE STE 211
BEND OR
97701-4630
US

IV. Provider business mailing address

2400 NE NEFF RD STE A
BEND OR
97701-6752
US

V. Phone/Fax

Practice location:
  • Phone: 541-320-7930
  • Fax:
Mailing address:
  • Phone: 541-389-3300
  • Fax: 541-389-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN60158012
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201407500RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60244781
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP4972
License Number StateAZ
# 5
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201500099NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: