Healthcare Provider Details

I. General information

NPI: 1912997529
Provider Name (Legal Business Name): LYNN MARIE HARVEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N 99 MSGS/SGCG
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

4700 LAS VEGAS BLVD N 99 MSGS/SGCG
NELLIS AFB NV
89191-6600
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2300
  • Fax: 702-653-2109
Mailing address:
  • Phone: 702-653-2300
  • Fax: 702-653-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number354
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: