MEDICARE: MARVETT MOHORN

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	372600000X	Adult Companion

General Provider Information

NPI Number	:	1285373076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARVETT MOHORN

Provider Business Mailing Address
First Line	:	PO BOX 620
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33302-0620
Country	:	US
Telephone Number	:	954-751-8529
Fax Number	:

Provider Business Practice Location Address
First Line	:	865 NW 16TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-7033
Country	:	US
Telephone Number	:	954-529-7841
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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