Provider Demographics
NPI:1174262596
Name:HARLESS, DAVID (NP-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:HARLESS
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 S STEEPLECHASE RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-4801
Mailing Address - Country:US
Mailing Address - Phone:435-817-3414
Mailing Address - Fax:
Practice Address - Street 1:3961 S STEEPLECHASE RD
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:UT
Practice Address - Zip Code:84780-4801
Practice Address - Country:US
Practice Address - Phone:435-817-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10836585-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner