Healthcare Provider Details

I. General information

NPI: 1114065232
Provider Name (Legal Business Name): NANCY MAYBETH HARVEY RN, BSN, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SHEEP SPRINGS WAY
JEMEZ PUEBLO NM
87024
US

IV. Provider business mailing address

11901 LEXINGTON AVE NE
ALBUQUERQUE NM
87112-1844
US

V. Phone/Fax

Practice location:
  • Phone: 505-834-7413
  • Fax: 505-834-7517
Mailing address:
  • Phone: 505-834-7419
  • Fax: 505-834-9167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number028516
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: