Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209002533 | IL |
NPI | 1013121177 |
---|---|
Provider Name | Ann M Harvey |
First Address | Woodridge, IL 60517-4903 |
Second Address | Chicago, IL 60657-5147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1316998578 | GROUP PRACTICE NPI (01) | IL |
P87977 | (02) | IL |