Healthcare Provider Details

I. General information

NPI: 1982927489
Provider Name (Legal Business Name): VIVINE MARCIA STONE DNAP,CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIVINE MARCIA SENIOR DNAP, CRNA

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 GRASSLANDS RD
VALHALLA NY
10595-1652
US

IV. Provider business mailing address

68 SOUTH SERVICE ROAD SUITE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 914-493-7857
  • Fax:
Mailing address:
  • Phone: 516-945-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number530769
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberTLRN074076
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: