Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | SO003153D | PA |
NPI | 1003141623 |
---|---|
Provider Name | Debra Harvey |
First Address | Philadelphia, PA 19120-2421 |
Second Address | Holland, PA 18966-1733 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/10/2009 |
Last Update Date | 15/10/2009 |