Healthcare Provider Details

I. General information

NPI: 1225664386
Provider Name (Legal Business Name): MONICA A HARRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2020
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N FAIRVIEW DR
TACOMA WA
98406-1015
US

IV. Provider business mailing address

1078 S 800 E
PROVIDENCE UT
84332-2400
US

V. Phone/Fax

Practice location:
  • Phone: 253-777-1423
  • Fax: 206-673-8050
Mailing address:
  • Phone: 435-363-5770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number217314-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP611011578
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: