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Individual

MR. HARRISON H DETROJA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSN, PMHNP-BC

Contact information

Practice address
720 14TH AVE, LONGVIEW, WA 98632-2315
(360) 423-0203
(360) 577-0187
Mailing address
PO BOX 1847, LONGVIEW, WA 98632-8140
(360) 423-0203
(360) 577-0187

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
AP60302056
WA
363LF0000X
Family Nurse Practitioner
AP60302056
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP60302056
WA

Other

Enumeration date
08/30/2012
Last updated
11/16/2024
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