Provider Demographics
NPI:1811004591
Name:HARVEY, SARAH JOSEPHINE (NP, CDE)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JOSEPHINE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:NP, CDE
Other - Prefix:MS
Other - First Name:SALLY
Other - Middle Name:JOSEPHINE
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP, CDE
Mailing Address - Street 1:401 BICENTENNIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2149
Mailing Address - Country:US
Mailing Address - Phone:707-571-4000
Mailing Address - Fax:707-571-3949
Practice Address - Street 1:401 BICENTENNIAL WAY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2149
Practice Address - Country:US
Practice Address - Phone:707-571-3916
Practice Address - Fax:707-571-3949
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN244633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F1106213OtherNATIONAL CERTIFICATION NP
CARN244633OtherSTATE LICENSE NUMBER
CARN244633OtherSTATE LICENSE NUMBER