Healthcare Provider Details

I. General information

NPI: 1083675847
Provider Name (Legal Business Name): WILLIAM G HARRIS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 SE COURT AVE
PENDLETON OR
97801
US

IV. Provider business mailing address

5319 SW WESTGATE DR 241
PORTLAND OR
97221-2432
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-5121
  • Fax:
Mailing address:
  • Phone: 503-297-7223
  • Fax: 503-297-7603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: