Provider Demographics
NPI:1023401627
Name:HARVEY, MARY DAM
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:DAM
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4627 ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98466-6301
Mailing Address - Country:US
Mailing Address - Phone:253-988-1253
Mailing Address - Fax:
Practice Address - Street 1:4627 ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98466-6301
Practice Address - Country:US
Practice Address - Phone:253-988-1253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00150813163WC0200X
WAAP 60630734363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care