Provider Demographics
NPI:1063750313
Name:HARMON, CALLI AL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CALLI
Middle Name:AL
Last Name:HARMON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CALLI
Other - Middle Name:A
Other - Last Name:LOMBARDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:415 LINDSEY RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-5955
Mailing Address - Country:US
Mailing Address - Phone:207-899-5808
Mailing Address - Fax:
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5717
Practice Address - Country:US
Practice Address - Phone:207-626-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1354363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical