Basic Information
| Provider Information | |||||||||
| NPI: | 1326546698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARNEY | ||||||||
| FirstName: | SOUNANTHA | ||||||||
| MiddleName: | SAYAVONGSA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3349 W 37TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802112717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2692081759 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2355 W 136TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOMFIELD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800239331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036589827 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2018 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0993323 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.