Provider Demographics
NPI:1619352101
Name:HARVEY, LEANN
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
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 1:170 W ROSE CITY RD
Mailing Address - Street 2:
Mailing Address - City:ROSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48654-9722
Mailing Address - Country:US
Mailing Address - Phone:989-387-4870
Mailing Address - Fax:
Practice Address - Street 1:79 RATHBONE ST
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-5957
Practice Address - Country:US
Practice Address - Phone:989-387-4870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-25
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703112374164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse