Provider Demographics
NPI:1497735450
Name:HARLAN, SHEILA MEGAN (CNM)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:MEGAN
Last Name:HARLAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-1709
Mailing Address - Country:US
Mailing Address - Phone:859-985-7196
Mailing Address - Fax:
Practice Address - Street 1:109 FOREST ST
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-1709
Practice Address - Country:US
Practice Address - Phone:859-985-7196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2511M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78251105Medicaid
KY78251105Medicaid