Healthcare Provider Details

I. General information

NPI: 1467095034
Provider Name (Legal Business Name): CONNIE R HARVEY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 LUCAS RD
MANSFIELD OH
44903-8682
US

IV. Provider business mailing address

1451 LUCAS RD
MANSFIELD OH
44903-8682
US

V. Phone/Fax

Practice location:
  • Phone: 419-589-5511
  • Fax:
Mailing address:
  • Phone: 419-589-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN247609
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: