Healthcare Provider Details

I. General information

NPI: 1558086330
Provider Name (Legal Business Name): PREVAL HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 CABIN CREEK DR
BURTONSVILLE MD
20866-1839
US

IV. Provider business mailing address

2908 CABIN CREEK DR
BURTONSVILLE MD
20866-1839
US

V. Phone/Fax

Practice location:
  • Phone: 301-257-0563
  • Fax: 414-800-1893
Mailing address:
  • Phone: 301-257-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. NOVA PREVAL
Title or Position: OWNER
Credential: CRNP
Phone: 301-257-0563