Provider Demographics
NPI:1104140268
Name:HARRIS, JOAN M (LMP)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1438
Mailing Address - Street 2:
Mailing Address - City:OMAK
Mailing Address - State:WA
Mailing Address - Zip Code:98841-1438
Mailing Address - Country:US
Mailing Address - Phone:509-846-1000
Mailing Address - Fax:509-846-1005
Practice Address - Street 1:670 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:OMAK
Practice Address - State:WA
Practice Address - Zip Code:98841
Practice Address - Country:US
Practice Address - Phone:509-846-1000
Practice Address - Fax:509-846-1005
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60083311174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist