Provider Demographics
NPI:1760753578
Name:HARVARD, KHIALE NORA
Entity Type:Individual
Prefix:
First Name:KHIALE
Middle Name:NORA
Last Name:HARVARD
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 1:12384 S ABBOTT DOWNING WAY
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-5693
Mailing Address - Country:US
Mailing Address - Phone:208-571-4018
Mailing Address - Fax:208-247-4312
Practice Address - Street 1:811 12TH AVE S
Practice Address - Street 2:#2
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4656
Practice Address - Country:US
Practice Address - Phone:208-571-4018
Practice Address - Fax:208-247-4312
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator