Healthcare Provider Details

I. General information

NPI: 1053612598
Provider Name (Legal Business Name): DONNA SUSAN HARMON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 N. MAIN STREET
TUBA CITY AZ
86045-0600
US

IV. Provider business mailing address

PO BOX 600
TUBA CITY AZ
86045-0600
US

V. Phone/Fax

Practice location:
  • Phone: 928-283-2629
  • Fax:
Mailing address:
  • Phone: 928-283-2501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332424
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License NumberRN1107752
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: