Provider Demographics
NPI:1801882170
Name:HARMON, MISCHELLE LINDA (CRNA)
Entity type:Individual
Prefix:MRS
First Name:MISCHELLE
Middle Name:LINDA
Last Name:HARMON
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MISCHELLE
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:70 RAINEY ST APT 1304
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4739
Mailing Address - Country:US
Mailing Address - Phone:256-777-9158
Mailing Address - Fax:
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3095
Practice Address - Country:US
Practice Address - Phone:585-922-4159
Practice Address - Fax:585-922-3731
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN79312367500000X
NY936684367500000X
AL1066139367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3633924Medicaid
TN3633924Medicaid