MEDICARE: MARY CHRISTINE HARVEY LM, CPM

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	176B00000X	Midwife	MD-96	ID

General Provider Information

NPI Number	:	1629636824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CHRISTINE HARVEY LM, CPM

Provider Business Mailing Address
First Line	:	10 W MAIN ST PARKER
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-5327
Country	:	US
Telephone Number	:	503-547-3615
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 W MAIN ST PARKER
Second Line	:
City	:	SAINT ANTHONY
State	:	ID
Zip	:	83445-5327
Country	:	US
Telephone Number	:	503-547-3615
Fax Number	:

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

Provider Enumeration Date	:	06/03/2019
Last Update Date	:	06/03/2019

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