Provider Demographics
NPI:1033233887
Name:HARVEY, MARY ELIZABETH (RN BSN, PHN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:HARVEY
Suffix:
Gender:F
Credentials:RN BSN, PHN
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:351 E POPPY ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-2932
Mailing Address - Country:US
Mailing Address - Phone:562-423-2522
Mailing Address - Fax:562-423-1647
Practice Address - Street 1:351 E POPPY ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-2932
Practice Address - Country:US
Practice Address - Phone:562-423-2522
Practice Address - Fax:562-423-1647
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA508483163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health