MEDICARE: DR. ERIN KATHLEEN HARNISH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	MD00035356	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	129048	OTHER	WA	WA LABOR & INDUSTRIES
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982695755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN KATHLEEN HARNISH M.D.

Provider Business Mailing Address
First Line	:	784 14TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2315
Country	:	US
Telephone Number	:	360-425-6111
Fax Number	:	360-636-1297

Provider Business Practice Location Address
First Line	:	784 14TH AVE
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-2315
Country	:	US
Telephone Number	:	360-425-6111
Fax Number	:	360-636-1297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	07/09/2007

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