Healthcare Provider Details

I. General information

NPI: 1306303243
Provider Name (Legal Business Name): MARIE NIRVA LOUIS-PAUL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CONRAD LN
NEW CITY NY
10956-6851
US

IV. Provider business mailing address

4 CONRAD LN
NEW CITY NY
10956-6851
US

V. Phone/Fax

Practice location:
  • Phone: 845-826-3118
  • Fax: 845-826-3118
Mailing address:
  • Phone: 845-826-3118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF340353-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number568006
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: