Healthcare Provider Details

I. General information

NPI: 1023855871
Provider Name (Legal Business Name): PATRICIA ANN HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3844 E PIMA ST
TUCSON AZ
85716-3308
US

IV. Provider business mailing address

3825 N VIA DE LA LUNA
TUCSON AZ
85749-8967
US

V. Phone/Fax

Practice location:
  • Phone: 520-477-7752
  • Fax:
Mailing address:
  • Phone: 805-660-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number266960
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: