Provider Demographics
NPI:1841569514
Name:WALTERS-HARVEY, JOLIENNE ADRIA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:JOLIENNE
Middle Name:ADRIA
Last Name:WALTERS-HARVEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:252 CROMBIE ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-1506
Mailing Address - Country:US
Mailing Address - Phone:631-223-2737
Mailing Address - Fax:
Practice Address - Street 1:79 MIDDLEVILLE ROAD
Practice Address - Street 2:DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401410-1363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health