Provider Demographics
NPI:1700688637
Name:HARVEY, MIA NICHELLE (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:NICHELLE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 BRATTAIN DR
Mailing Address - Street 2:
Mailing Address - City:IOWA COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:77583-4408
Mailing Address - Country:US
Mailing Address - Phone:346-493-0895
Mailing Address - Fax:
Practice Address - Street 1:3610 BRATTAIN DR
Practice Address - Street 2:
Practice Address - City:IOWA COLONY
Practice Address - State:TX
Practice Address - Zip Code:77583-4408
Practice Address - Country:US
Practice Address - Phone:346-493-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX900120163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty