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General NPI Number Information
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NPI Number | 1629591938
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Entity Type | Individual
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Provider Name | EBONY T L HARVEY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 05/24/2024
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Provider Practice Location Address
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Address Line | 3325 PALO VERDE AVE STE 201
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City | LONG BEACH
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State | CA
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Zip | 90808-4132
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Country | US
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Telephone | 562-542-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 1601 N SEPULVEDA BLVD # 133
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5111
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Country | US
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Telephone | 919-935-6808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95029942
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 207097
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License Number State | NC
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