Healthcare Provider Details

I. General information

NPI: 1235814823
Provider Name (Legal Business Name): MS. NOHEMY CARO HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2023
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12108 83RD AVE E
PUYALLUP WA
98373-4755
US

IV. Provider business mailing address

12108 83RD AVE E
PUYALLUP WA
98373-4755
US

V. Phone/Fax

Practice location:
  • Phone: 206-538-9507
  • Fax:
Mailing address:
  • Phone: 206-538-9507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number12876
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: