Provider Demographics
NPI:1992566764
Name:HARRIS-WHITE, ANTHONY CHAVEZ
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:CHAVEZ
Last Name:HARRIS-WHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 168TH ST S
Mailing Address - Street 2:
Mailing Address - City:SPANAWAY
Mailing Address - State:WA
Mailing Address - Zip Code:98387-8226
Mailing Address - Country:US
Mailing Address - Phone:360-819-3426
Mailing Address - Fax:
Practice Address - Street 1:103 168TH ST S
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8226
Practice Address - Country:US
Practice Address - Phone:253-327-9424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60113446163WG0000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice