Provider Demographics
NPI:1689733404
Name:HARRELL, LINDA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:HARRELL
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 1:675 E 78TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3307
Mailing Address - Country:US
Mailing Address - Phone:718-763-8773
Mailing Address - Fax:866-490-8874
Practice Address - Street 1:3414 CHURCH AVE
Practice Address - Street 2:CARIBBEAN AMERICAN FAMILY HEALTH CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2714
Practice Address - Country:US
Practice Address - Phone:718-630-2197
Practice Address - Fax:718-940-2914
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000079367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02232277Medicaid
NY02232277Medicaid