Healthcare Provider Details

I. General information

NPI: 1174015234
Provider Name (Legal Business Name): EMILY HARRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2018
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WESTLAKE AVE N STE 400
SEATTLE WA
98109-6211
US

IV. Provider business mailing address

1505 WESTLAKE AVE N STE 400
SEATTLE WA
98109-6211
US

V. Phone/Fax

Practice location:
  • Phone: 206-301-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.PA.61320442
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: