Healthcare Provider Details

I. General information

NPI: 1164204558
Provider Name (Legal Business Name): MICHELLE R PURVILLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 GRAND CONCOURSE
BRONX NY
10453-4303
US

IV. Provider business mailing address

246 E 4TH ST
MOUNT VERNON NY
10553-1403
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-7736
  • Fax: 347-479-1303
Mailing address:
  • Phone: 321-298-5626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350337
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: