Provider Demographics
NPI:1336618651
Name:HARVEY, DIANNA GAYLE
Entity Type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:GAYLE
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 1:5228 NW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-5315
Mailing Address - Country:US
Mailing Address - Phone:405-326-9058
Mailing Address - Fax:
Practice Address - Street 1:4825 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-1800
Practice Address - Country:US
Practice Address - Phone:405-896-8426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1477914166OtherLANDMARK RECOVERY