Healthcare Provider Details

I. General information

NPI: 1033786223
Provider Name (Legal Business Name): DIANE MARIE HARKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 E 1ST ST STE 110
PORT ANGELES WA
98362-4990
US

IV. Provider business mailing address

1120 OLYMPUS AVE
PORT ANGELES WA
98362-2735
US

V. Phone/Fax

Practice location:
  • Phone: 360-457-3456
  • Fax: 360-457-5293
Mailing address:
  • Phone: 509-901-3541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberVA00066587
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: