Provider Demographics
NPI:1942424445
Name:HARVEY, MARY JANE
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
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 1:943 WEST 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052
Mailing Address - Country:US
Mailing Address - Phone:440-371-3858
Mailing Address - Fax:
Practice Address - Street 1:1608 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052
Practice Address - Country:US
Practice Address - Phone:440-288-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN080495164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse