Healthcare Provider Details

I. General information

NPI: 1952037566
Provider Name (Legal Business Name): BETTINA HARVEY ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 BH HARVEY TRL LOT H
BURLINGTON NC
27217-7618
US

IV. Provider business mailing address

667 BH HARVEY TRL LOT H
BURLINGTON NC
27217-7618
US

V. Phone/Fax

Practice location:
  • Phone: 336-350-7685
  • Fax:
Mailing address:
  • Phone: 336-539-5176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License NumberFOO184
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: