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NPI Code Detail

MEDICARE: MAVIS GYAN RN

MEDICARE: MAVIS GYAN RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse692256NY

General Provider Information

NPI Number : 1528461571
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAVIS GYAN RN
Provider Business Mailing Address
First Line : 780 CONCOURSE VLG W APT 5F
Second Line :
City : BRONX
State : NY
Zip : 10451-3811
Country : US
Telephone Number : 718-690-0961
Fax Number :
Provider Business Practice Location Address
First Line : 780 CONCOURSE VLG W APT 5F
Second Line :
City : BRONX
State : NY
Zip : 10451-3811
Country : US
Telephone Number : 718-690-0961
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2014
Last Update Date : 10/06/2014

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