=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285596155
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORVELL FAMILY PRACTICE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4130 LINDEN AVE STE 280
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45432-3073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-416-4186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4130 LINDEN AVE STE 280
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45432-3073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-416-4186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NICHOLE M NORVELL
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 937-416-4186
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------