Provider Demographics
NPI:1962160549
Name:HARVEY, MICHELLE VICTORIA- DOMINIQUE (PA-C)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:VICTORIA- DOMINIQUE
Last Name:HARVEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2155
Mailing Address - Country:US
Mailing Address - Phone:704-694-6700
Mailing Address - Fax:704-695-1227
Practice Address - Street 1:203 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2155
Practice Address - Country:US
Practice Address - Phone:704-694-6700
Practice Address - Fax:704-695-1227
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11821363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-11821OtherMEDICAL LICENSE