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NPI Code Detail

MEDICARE: MS. MICHELLE VICTORIA- DOMINIQUE HARVEY PA-C

MEDICARE: MS. MICHELLE VICTORIA- DOMINIQUE HARVEY PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant0010-11821NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10010-11821OTHERNCMEDICAL LICENSE

General Provider Information

NPI Number : 1962160549
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MICHELLE VICTORIA- DOMINIQUE HARVEY PA-C
Provider Business Mailing Address
First Line : 203 SALISBURY ST
Second Line :
City : WADESBORO
State : NC
Zip : 28170-2155
Country : US
Telephone Number : 704-694-6700
Fax Number : 704-695-1227
Provider Business Practice Location Address
First Line : 203 SALISBURY ST
Second Line :
City : WADESBORO
State : NC
Zip : 28170-2155
Country : US
Telephone Number : 704-694-6700
Fax Number : 704-695-1227
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2021
Last Update Date : 06/19/2023

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