Provider Demographics
NPI:1023289006
Name:HARVEY, JUDITH ANNE (LPN)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6721
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-6721
Mailing Address - Country:US
Mailing Address - Phone:307-690-1981
Mailing Address - Fax:
Practice Address - Street 1:580 RODEO DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-6721
Practice Address - Country:US
Practice Address - Phone:307-690-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3803164W00000X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child