Provider Demographics
NPI:1770858805
Name:POMIDOR, MICHELLE A (CRNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:POMIDOR
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANN
Other - Last Name:PHILLIPPY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:50 N 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1440
Mailing Address - Country:US
Mailing Address - Phone:717-234-2561
Mailing Address - Fax:717-236-1121
Practice Address - Street 1:205 SOUTH FRONT STREET
Practice Address - Street 2:6TH FL BMA
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17104-1619
Practice Address - Country:US
Practice Address - Phone:717-988-9370
Practice Address - Fax:717-703-0154
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011896363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1609534OtherGATEWAY MEDICARE ASSURED
PA1609534OtherGATEWAY MEDICARE ASSURED