Provider Demographics
NPI:1376709014
Name:HARNISH, LAZETTE ROSE (LMT)
Entity Type:Individual
Prefix:
First Name:LAZETTE
Middle Name:ROSE
Last Name:HARNISH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 NE CORNELL RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-6498
Mailing Address - Country:US
Mailing Address - Phone:503-530-8517
Mailing Address - Fax:
Practice Address - Street 1:5160 NW NEAKAHNIE AVE
Practice Address - Street 2:#32
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-1932
Practice Address - Country:US
Practice Address - Phone:503-530-8517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist