Healthcare Provider Details

I. General information

NPI: 1366439606
Provider Name (Legal Business Name): MICHELLE MARIE HARMON WOMENS HEALTH CARE N
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 W CASABLANCA CANNON AFB BLDG 1400 27 MEDICAL GROUP
CLOVIS NM
88103-5014
US

IV. Provider business mailing address

208 W CASABLANCA CANNON AFB27 BLDG 1400 27 MEDICAL GROUP
CLOVIS NM
88103-5014
US

V. Phone/Fax

Practice location:
  • Phone: 505-784-6608
  • Fax: 505-784-6028
Mailing address:
  • Phone: 505-784-6608
  • Fax: 505-784-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberRN244354
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: