MEDICARE: MARVA JAY LVN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	009923	TX

General Provider Information

NPI Number	:	1134136575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVA JAY LVN

Provider Business Mailing Address
First Line	:	8500 N STEMMONS FWY STE 5011
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-3832
Country	:	US
Telephone Number	:	972-685-0644
Fax Number	:	214-677-6954

Provider Business Practice Location Address
First Line	:	8500 N STEMMONS FWY STE 5011
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-3832
Country	:	US
Telephone Number	:	972-685-0644
Fax Number	:	214-677-6954

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	05/19/2021

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Directions to “ MARVA JAY LVN” Practice Location

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