Provider Demographics
NPI:1033574330
Name:HARMON, MELISSA ROSE (QMAP 171M00000X)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:HARMON
Suffix:
Gender:F
Credentials:QMAP 171M00000X
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5571 US HIGHWAY 20 LOT 1
Mailing Address - Street 2:
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889-9410
Mailing Address - Country:US
Mailing Address - Phone:419-554-8692
Mailing Address - Fax:
Practice Address - Street 1:1234 BELL
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017
Practice Address - Country:US
Practice Address - Phone:720-292-8331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program