Provider Demographics
NPI:1679616791
Name:HARMS, SHELLIE L (PA)
Entity Type:Individual
Prefix:
First Name:SHELLIE
Middle Name:L
Last Name:HARMS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:47 WIDEFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-2126
Mailing Address - Country:US
Mailing Address - Phone:719-390-4335
Mailing Address - Fax:719-390-4566
Practice Address - Street 1:47 WIDEFIELD BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-2126
Practice Address - Country:US
Practice Address - Phone:719-282-6100
Practice Address - Fax:719-282-6106
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO998363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COQ10784Medicare UPIN