Provider Demographics
NPI:1942304019
Name:HARMON, SHERRY L (NP, CNM)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:HARMON
Suffix:
Gender:F
Credentials:NP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 W 300 N
Mailing Address - Street 2:
Mailing Address - City:FAIRLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46126-9413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E COUNTY LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1046
Practice Address - Country:US
Practice Address - Phone:317-497-6333
Practice Address - Fax:317-497-6334
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000102A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000528280OtherANTHEM
IN200864190Medicaid
IN000000654485OtherANTHEM
INQ79129Medicare UPIN
IN000000528280OtherANTHEM
IN000000654485OtherANTHEM
IN200864190Medicaid