Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OP60781742 | WA |
NPI | 1003254442 |
---|---|
Provider Name | Tonya Harris |
First Address | Puyallup, WA 98373-3709 |
Second Address | Puyallup, WA 98373-3709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2013 |
Last Update Date | 26/02/2020 |