Provider Demographics
NPI:1720425275
Name:HARNS, ROBERTA MARLENE (LMP)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:MARLENE
Last Name:HARNS
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 1:403 E LONGFELLOW AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1629
Mailing Address - Country:US
Mailing Address - Phone:509-828-8248
Mailing Address - Fax:
Practice Address - Street 1:403 E LONGFELLOW AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1629
Practice Address - Country:US
Practice Address - Phone:509-828-8248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00004683172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker