=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124983655
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANNA HARRIS RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/17/2025
-----------------------------------------------------
Last Update Date | 12/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2555 MARVIN RD NE
-----------------------------------------------------
City | LACEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98516-3138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-413-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9014 50TH AVE SE
-----------------------------------------------------
City | LACEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98513-4315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-413-4200
-----------------------------------------------------
Fax | 360-413-4226
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | R0136083
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------