Provider Demographics
NPI:1710535380
Name:HARVEY, PETER (AANP)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:HARVEY
Suffix:
Gender:M
Credentials:AANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 KNIGHTSBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-2477
Mailing Address - Country:US
Mailing Address - Phone:907-378-1382
Mailing Address - Fax:
Practice Address - Street 1:755 KNIGHTSBRIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-2477
Practice Address - Country:US
Practice Address - Phone:907-378-1382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK149236363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily