Individual
MIMI HARZAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSPA, PA-C
Contact information
Practice address
2200 NE NEFF RD STE 302, BEND, OR 97701-4279
(541) 706-6915
(541) 706-6733
Mailing address
PO BOX 3988, CARBONDALE, IL 62902-3988
(618) 457-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085008538
IL
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/13/2020
Last updated
10/01/2025
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