Provider Demographics
NPI:1881877629
Name:HARVILLE, DEBRA H (LOT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:H
Last Name:HARVILLE
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CHAVIS SQ
Mailing Address - Street 2:P. O. BOX 367
Mailing Address - City:DEQUINCY
Mailing Address - State:LA
Mailing Address - Zip Code:70633-3345
Mailing Address - Country:US
Mailing Address - Phone:337-786-4881
Mailing Address - Fax:
Practice Address - Street 1:112 CHAVIS SQ
Practice Address - Street 2:
Practice Address - City:DEQUINCY
Practice Address - State:LA
Practice Address - Zip Code:70633-3345
Practice Address - Country:US
Practice Address - Phone:337-786-4881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAZ10388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist