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Individual

MICHEALLE G HARRISON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNP

Contact information

Practice address
8800 WALTHER BLVD, BALTIMORE, MD 21234-9001
(410) 882-3240
(410) 661-5093
Mailing address
701 MAIDEN CHOICE LN, BALTIMORE, MD 21228-5968

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R171944
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0051
BCBS DC
01
093NER-892347-01
CAREFIRST BCBS OF MD
01
093NSE-892347-01
CAREFIRST BCBS OF MD
01
0943ER-892347-02
CAREFIRST BCBS OF MD
05
411440000
MD
01
83-03374
EVERCARE
01
89234701
CAREFIRST MD
01
9676-0037
CAREFIRST BCBS OF DC
Enumeration date
08/04/2006
Last updated
07/17/2009
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