Provider Demographics
NPI:1295958593
Name:HARRIS, STEPHANIE ANN (RNC, BCIAC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RNC, BCIAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8523 224TH ST SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8253
Mailing Address - Country:US
Mailing Address - Phone:425-778-8073
Mailing Address - Fax:
Practice Address - Street 1:8523 224TH ST SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8253
Practice Address - Country:US
Practice Address - Phone:425-672-1676
Practice Address - Fax:425-672-1676
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00095884174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA841220OtherDSHS
WA155775201629OtherPREMERA BLUE CROSS
WA0049143OtherL&I