Individual provider Active NPI

Bradford J Harnetiaux, ARNP

  • Pediatric Nurse Practitioner
  • Spokane Valley, WA
National Provider Identifier
1487718623
Registry record updated Aug 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
AP30001441 Issued in WA
Practice address
1414 N Vercler
Building 1
Spokane Valley, WA 99216-1092
Phone
(509) 928-6383
Fax
(509) 926-9420
NPI assigned
Dec 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X AP30001441 WA Primary

Addresses

Primary practice location

1414 N Vercler
Building 1
Spokane Valley, WA 99216-1092

Mailing address

1414 N Vercler Rd
Building 1
Spokane Valley, WA 99216-1092
Phone (509) 928-6383

Other identifiers 1

IdentifierTypeStateIssuer
1011616MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AP30001441WAMDPediatric Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312156800000",
    "number": "1487718623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 N VERCLER RD",
            "address_2": "BUILDING 1",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161092",
            "telephone_number": "509-928-6383",
            "fax_number": "509-926-9420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1414 N VERCLER",
            "address_2": "BUILDING 1",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992161092",
            "telephone_number": "509-928-6383",
            "fax_number": "509-926-9420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARNETIAUX",
        "first_name": "BRADFORD",
        "middle_name": "J",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-21",
        "last_updated": "2011-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "WA",
            "license": "AP30001441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1011616",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.