MEDICARE: ROSANNE ELIZABETH HARMON PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	094000471N6	OR

General Provider Information

NPI Number	:	1891320669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSANNE ELIZABETH HARMON PMHNP

Provider Business Mailing Address
First Line	:	13481 APPLEGATE TER
Second Line	:
City	:	OREGON CITY
State	:	OR
Zip	:	97045-2803
Country	:	US
Telephone Number	:	503-816-2554
Fax Number	:

Provider Business Practice Location Address
First Line	:	3920 E ASHWOOD RD
Second Line	:
City	:	MADRAS
State	:	OR
Zip	:	97741-9703
Country	:	US
Telephone Number	:	541-325-5189
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2020
Last Update Date	:	03/11/2020

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