Healthcare Provider Details

I. General information

NPI: 1225985716
Provider Name (Legal Business Name): MICHELLE C HARRISON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 05/10/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42055 50TH ST W STE 10
QUARTZ HILL CA
93536-3520
US

IV. Provider business mailing address

2517 PAINTBRUSH DR
PALMDALE CA
93551-6209
US

V. Phone/Fax

Practice location:
  • Phone: 661-478-8016
  • Fax:
Mailing address:
  • Phone: 510-681-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039136
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number764985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: