Basic Information
| Provider Information | |||||||||
| NPI: | 1689733404 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRELL | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C.N.M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 675 E 78TH ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112363307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187638773 | ||||||||
| FaxNumber: | 8664908874 | ||||||||
| Practice Location | |||||||||
| Address1: | 3414 CHURCH AVE | ||||||||
| Address2: | CARIBBEAN AMERICAN FAMILY HEALTH CENTER | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186302197 | ||||||||
| FaxNumber: | 7189402914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2006 | ||||||||
| LastUpdateDate: | 03/07/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | F000079 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | 02232277 | 05 | NY | MEDICAID |