MEDICARE: MRS. KATHLEEN THERESA HARVEY RN

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	163WS0200X	School Registered Nurse	491685-1	NY

General Provider Information

NPI Number	:	1790189066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN THERESA HARVEY RN

Provider Business Mailing Address
First Line	:	29 CONCORD BLVD
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1003
Country	:	US
Telephone Number	:	313-525-9065
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 CONCORD BLVD
Second Line	:
City	:	CLINTON
State	:	NY
Zip	:	13323-1003
Country	:	US
Telephone Number	:	315-525-9065
Fax Number	:

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

Provider Enumeration Date	:	10/15/2014
Last Update Date	:	10/15/2014

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