Healthcare Provider Details

I. General information

NPI: 1477850998
Provider Name (Legal Business Name): MRS. LORI NALVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 02/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1958 DAIRY RD
MELBOURNE FL
32904-4045
US

IV. Provider business mailing address

1995 CANTERBURY DR
INDIALANTIC FL
32903-4028
US

V. Phone/Fax

Practice location:
  • Phone: 321-409-0010
  • Fax:
Mailing address:
  • Phone: 321-917-1778
  • Fax: 321-676-1376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN 3147302
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: