Provider Demographics
NPI:1497260178
Name:HARVEY, JEAN EVADNEY
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:EVADNEY
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 1:1400 E WEST HWY APT 603
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3257
Mailing Address - Country:US
Mailing Address - Phone:954-274-3538
Mailing Address - Fax:
Practice Address - Street 1:1400 E WEST HWY APT 603
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3257
Practice Address - Country:US
Practice Address - Phone:954-274-3538
Practice Address - Fax:954-274-3538
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1031091163W00000X, 163WG0000X
DC1031091163W00000X
FLRN2571122163WD0400X
FL050812163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No163WD0400XNursing Service ProvidersRegistered NurseDiabetes EducatorGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty