Healthcare Provider Details

I. General information

NPI: 1588359103
Provider Name (Legal Business Name): MARKEITIA PURVIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 04/10/2023
Certification Date: 04/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5548 BOYER ST
PHILADELPHIA PA
19138-2306
US

IV. Provider business mailing address

229 W UPSAL ST APT B06
PHILADELPHIA PA
19119-4001
US

V. Phone/Fax

Practice location:
  • Phone: 267-976-7630
  • Fax:
Mailing address:
  • Phone: 215-279-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number718366
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number718366
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number718366
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number718366
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number718388
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number718366
License Number StatePA
# 7
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number718366
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: