Provider Demographics
NPI:1477527299
Name:HARVEY, LISA ELLEN (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELLEN
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414
Mailing Address - Country:US
Mailing Address - Phone:307-578-2480
Mailing Address - Fax:307-578-2492
Practice Address - Street 1:424 YELLOWSTONE AVE
Practice Address - Street 2:STE 120
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414
Practice Address - Country:US
Practice Address - Phone:307-578-7207
Practice Address - Fax:307-578-1256
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400810207Q00000X
WYTL1383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200400810OtherSTATE LICENSE