MEDICARE: MS. MARCIE L HARVEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	132700000X	Dietary Manager

General Provider Information

NPI Number	:	1093975963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIE L HARVEY

Provider Business Mailing Address
First Line	:	2738 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1832
Country	:	US
Telephone Number	:	773-239-0355
Fax Number	:	773-239-0357

Provider Business Practice Location Address
First Line	:	2738 W 111TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1832
Country	:	US
Telephone Number	:	773-239-0355
Fax Number	:	773-239-0357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2008
Last Update Date	:	06/13/2008

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