Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP60217378 | WA |
NPI | 1073897849 |
---|---|
Provider Name | Antonette Lynn Harvill |
First Address | Kennewick, WA 99337-5092 |
Second Address | Richland, WA 99352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2011 |
Last Update Date | 27/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025904 | KRMC L&I GROUP NUMBER (01) | WA |
1073897849 | (05) | WA |