Healthcare Provider Details

I. General information

NPI: 1154262046
Provider Name (Legal Business Name): MARILINE CORVIL PMHNP, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13770 FRONTIER CT STE 100
BURNSVILLE MN
55337-4811
US

IV. Provider business mailing address

13770 FRONTIER CT STE 100
BURNSVILLE MN
55337-4811
US

V. Phone/Fax

Practice location:
  • Phone: 651-703-6566
  • Fax: 952-516-5103
Mailing address:
  • Phone: 651-703-6566
  • Fax: 952-516-5103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10059184
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number14159
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: