Healthcare Provider Details

I. General information

NPI: 1568475119
Provider Name (Legal Business Name): MARIE L HARRIS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIE L BACON

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 GOETHALS DR STE 200
RICHLAND WA
99352-3552
US

IV. Provider business mailing address

550 GAGE BLVD STE 101
RICHLAND WA
99352-9532
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-2555
  • Fax: 509-942-0321
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-627-2983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP30003633
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: