Provider Demographics
NPI:1326546698
Name:HARNEY, SOUNANTHA SAYAVONGSA
Entity Type:Individual
Prefix:
First Name:SOUNANTHA
Middle Name:SAYAVONGSA
Last Name:HARNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3349 W 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-2717
Mailing Address - Country:US
Mailing Address - Phone:269-208-1759
Mailing Address - Fax:
Practice Address - Street 1:2355 W 136TH AVE
Practice Address - Street 2:
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-9331
Practice Address - Country:US
Practice Address - Phone:303-658-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-31
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0993323363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily