Healthcare Provider Details

I. General information

NPI: 1275935751
Provider Name (Legal Business Name): HEATHER CHERI HARBY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 11TH AVE NE SUITE 200
SEATTLE WA
98105-6366
US

IV. Provider business mailing address

341 W PINE ST SUITE 200
MISSOULA MT
59802-4119
US

V. Phone/Fax

Practice location:
  • Phone: 206-616-4001
  • Fax:
Mailing address:
  • Phone: 406-327-0269
  • Fax: 406-327-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMED-PAC-LIC-44376
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: