Healthcare Provider Details

I. General information

NPI: 1487718623
Provider Name (Legal Business Name): BRADFORD J HARNETIAUX ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 N VERCLER BUILDING 1
SPOKANE VALLEY WA
99216-1092
US

IV. Provider business mailing address

1414 N VERCLER RD BUILDING 1
SPOKANE VALLEY WA
99216-1092
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-6383
  • Fax: 509-926-9420
Mailing address:
  • Phone: 509-928-6383
  • Fax: 509-926-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30001441
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: