Provider Demographics
NPI:1629731021
Name:HARMAN, AMELIA (NP)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:HARMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 E CANYON RIM RD STE 105B
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-4313
Mailing Address - Country:US
Mailing Address - Phone:714-900-3091
Mailing Address - Fax:714-386-5147
Practice Address - Street 1:6200 E CANYON RIM RD STE 105B
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-4313
Practice Address - Country:US
Practice Address - Phone:714-900-3091
Practice Address - Fax:714-386-5147
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner