Healthcare Provider Details

I. General information

NPI: 1124983655
Provider Name (Legal Business Name): BRIANNA HARRIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 MARVIN RD NE
LACEY WA
98516-3138
US

IV. Provider business mailing address

9014 50TH AVE SE
LACEY WA
98513-4315
US

V. Phone/Fax

Practice location:
  • Phone: 360-413-4200
  • Fax:
Mailing address:
  • Phone: 360-413-4200
  • Fax: 360-413-4226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR0136083
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: