Provider Demographics
NPI:1730670837
Name:HARVEY, MARISSA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:JEAN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 STICKNEY PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1554
Mailing Address - Country:US
Mailing Address - Phone:516-244-4732
Mailing Address - Fax:516-977-3025
Practice Address - Street 1:1454 STICKNEY PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-1554
Practice Address - Country:US
Practice Address - Phone:516-244-4732
Practice Address - Fax:516-977-3025
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-23
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY331310-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse