Healthcare Provider Details

I. General information

NPI: 1497260178
Provider Name (Legal Business Name): MRS. JEAN EVADNEY HARVEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2017
Last Update Date: 12/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E WEST HWY APT 603
SILVER SPRING MD
20910-3257
US

IV. Provider business mailing address

1400 E WEST HWY APT 603
SILVER SPRING MD
20910-3257
US

V. Phone/Fax

Practice location:
  • Phone: 954-274-3538
  • Fax: 954-274-3538
Mailing address:
  • Phone: 954-274-3538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1031091
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1031091
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN2571122
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN1031091
License Number StateDC
# 5
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number050812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: