Provider Demographics
NPI:1184221400
Name:HARVEY, CAMILLE B
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:B
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:PO BOX 241
Mailing Address - Street 2:
Mailing Address - City:HAZEN
Mailing Address - State:ND
Mailing Address - Zip Code:58545-0241
Mailing Address - Country:US
Mailing Address - Phone:701-891-9007
Mailing Address - Fax:
Practice Address - Street 1:222 1ST AVE NW
Practice Address - Street 2:
Practice Address - City:HAZEN
Practice Address - State:ND
Practice Address - Zip Code:58545-4312
Practice Address - Country:US
Practice Address - Phone:701-891-9007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant