Provider Demographics
NPI:1366439606
Name:HARMON, MICHELLE MARIE (WOMENS HEALTH CARE N)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARIE
Last Name:HARMON
Suffix:
Gender:F
Credentials:WOMENS HEALTH CARE N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 W CASABLANCA CANNON AFB27
Mailing Address - Street 2:BLDG 1400 27 MEDICAL GROUP
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88103-5014
Mailing Address - Country:US
Mailing Address - Phone:505-784-6608
Mailing Address - Fax:505-784-6028
Practice Address - Street 1:208 W CASABLANCA CANNON AFB
Practice Address - Street 2:BLDG 1400 27 MEDICAL GROUP
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88103-5014
Practice Address - Country:US
Practice Address - Phone:505-784-6608
Practice Address - Fax:505-784-6028
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN244354363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11101OtherACNM CERTIFICATION COUNCI
VAD000Medicare UPIN