Provider Demographics
NPI:1821239922
Name:HARLAN, PEGAH VAHDAT (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:PEGAH
Middle Name:VAHDAT
Last Name:HARLAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PEGAH
Other - Middle Name:
Other - Last Name:DAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:945 W THREEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-4401
Mailing Address - Country:US
Mailing Address - Phone:515-339-6994
Mailing Address - Fax:
Practice Address - Street 1:945 W THREEWOOD CT
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-4401
Practice Address - Country:US
Practice Address - Phone:515-339-6994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA114627367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered