Provider Demographics
NPI:1538189782
Name:HARRIES, LINDA (PA-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:HARRIES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 SOUTHGATE, STE 6
Mailing Address - Street 2:PO BOX 1125
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801
Mailing Address - Country:US
Mailing Address - Phone:541-215-1564
Mailing Address - Fax:541-215-1567
Practice Address - Street 1:1600 SE COURT PL
Practice Address - Street 2:SUITE 201
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3281
Practice Address - Country:US
Practice Address - Phone:541-276-1700
Practice Address - Fax:541-276-6327
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0000QGFSHMedicare ID - Type Unspecified
ORT95356Medicare UPIN