Provider Demographics
NPI:1083716674
Name:HARAWAY, LINDA JUANITA (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:JUANITA
Last Name:HARAWAY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 COUNTY ROAD 55
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35652-3313
Mailing Address - Country:US
Mailing Address - Phone:256-710-7073
Mailing Address - Fax:
Practice Address - Street 1:635 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5313
Practice Address - Country:US
Practice Address - Phone:256-764-3431
Practice Address - Fax:256-766-4672
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000011876363LF0000X
AL1-027030363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily