Healthcare Provider Details

I. General information

NPI: 1487010336
Provider Name (Legal Business Name): EBONI NORVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 MORNINGSIDE AVE
NEW YORK NY
10027-4802
US

IV. Provider business mailing address

11548 122ND ST
SOUTH OZONE PARK NY
11420-2512
US

V. Phone/Fax

Practice location:
  • Phone: 212-923-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number694867
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: