Healthcare Provider Details

I. General information

NPI: 1699530212
Provider Name (Legal Business Name): JMARVEL MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16644 SHOAL RD
LEWES DE
19958-7006
US

IV. Provider business mailing address

16644 SHOAL RD
LEWES DE
19958-7006
US

V. Phone/Fax

Practice location:
  • Phone: 302-271-4669
  • Fax: 302-703-6634
Mailing address:
  • Phone: 302-271-4669
  • Fax: 302-703-6634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOAAN C MARVEL
Title or Position: OWNER
Credential: NP
Phone: 302-271-4669