=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225664386
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MONICA A HARRIS FNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2020
-----------------------------------------------------
Last Update Date | 12/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 630 N FAIRVIEW DR
-----------------------------------------------------
City | TACOMA
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98406-1015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 253-777-1423
-----------------------------------------------------
Fax | 206-673-8050
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1078 S 800 E
-----------------------------------------------------
City | PROVIDENCE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84332-2400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-363-5770
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 217314-4405
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP611011578
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------