Provider Demographics
NPI:1255692539
Name:HARVEY, SANDRA LEE
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:LEE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:GARISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1073 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-2028
Mailing Address - Country:US
Mailing Address - Phone:419-438-8813
Mailing Address - Fax:
Practice Address - Street 1:1073 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-2028
Practice Address - Country:US
Practice Address - Phone:419-438-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH324024660904376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide