Basic Information
| Provider Information | |||||||||
| NPI: | 1942554175 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARPER | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1424 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257892000 | ||||||||
| FaxNumber: | 4257892096 | ||||||||
| Practice Location | |||||||||
| Address1: | 1424 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982011720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257892000 | ||||||||
| FaxNumber: | 4257892096 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2012 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 60318228 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 60318228 | 01 | WA | PA WA LICENSE | OTHER | PA22655 | 01 | CA | MEDICAL LICENSE | OTHER |