Provider Demographics
NPI:1093975963
Name:HARVEY, MARCIE L
Entity Type:Individual
Prefix:MS
First Name:MARCIE
Middle Name:L
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 1:2738 W 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1832
Mailing Address - Country:US
Mailing Address - Phone:773-239-0355
Mailing Address - Fax:773-239-0357
Practice Address - Street 1:2738 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1832
Practice Address - Country:US
Practice Address - Phone:773-239-0355
Practice Address - Fax:773-239-0357
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes132700000XDietary & Nutritional Service ProvidersDietary Manager