Healthcare Provider Details

I. General information

NPI: 1619030046
Provider Name (Legal Business Name): SUSAN HARRIS NIVERT ARNP CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 EAST MADISON SUITE 301
SEATTLE WA
98112-4752
US

IV. Provider business mailing address

342 NW 79TH ST
SEATTLE WA
98117-4015
US

V. Phone/Fax

Practice location:
  • Phone: 206-389-9981
  • Fax:
Mailing address:
  • Phone: 206-389-9981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAP30003787
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: