Provider Demographics
NPI:1073897849
Name:HARVILL, ANTONETTE LYNN (ARNP)
Entity Type:Individual
Prefix:
First Name:ANTONETTE
Middle Name:LYNN
Last Name:HARVILL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:ANTONETTE
Other - Middle Name:L
Other - Last Name:CIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NNP-BC
Mailing Address - Street 1:3900 S ZINTEL WAY
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99337-5092
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-942-2268
Practice Address - Street 1:888 SWIFT BLVD.
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352
Practice Address - Country:US
Practice Address - Phone:509-946-4611
Practice Address - Fax:509-942-2887
Is Sole Proprietor?:No
Enumeration Date:2011-09-28
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60217378363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1073897849Medicaid
WA025904OtherKRMC L&I GROUP NUMBER
WA025904OtherKRMC L&I GROUP NUMBER