Provider Demographics
NPI:1386237402
Name:HARRY, MORGAN KRISTINA
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:KRISTINA
Last Name:HARRY
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 1:21101 121ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-6809
Mailing Address - Country:US
Mailing Address - Phone:206-794-7979
Mailing Address - Fax:360-668-3496
Practice Address - Street 1:11421 31ST DR SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-5273
Practice Address - Country:US
Practice Address - Phone:206-794-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61090814163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA163W00000XMedicaid