Individual
MRS. THERESA DIANE HARVEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DT
Contact information
Practice address
2502 WHITMIRE DR, ROCKFORD, IL 61109-6732
(815) 873-1910
Mailing address
2502 WHITMIRE DR, ROCKFORD, IL 61109-6732
(815) 873-1910
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
07/22/2008
Last updated
07/22/2008
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