Provider Demographics
NPI:1801071386
Name:HARVEY, JUDY ANN (RD)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:ANN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-0550
Mailing Address - Country:US
Mailing Address - Phone:541-830-0333
Mailing Address - Fax:541-830-0863
Practice Address - Street 1:275 LOTO ST
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-9517
Practice Address - Country:US
Practice Address - Phone:541-830-0333
Practice Address - Fax:541-830-0863
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR133N00000X, 133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist