MEDICARE: MARIE NINVAL

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	164W00000X	Licensed Practical Nurse	292881	NY
2	163W00000X	Registered Nurse	699564	NY

General Provider Information

NPI Number	:	1508017765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE NINVAL

Provider Business Mailing Address
First Line	:	1322 E 83RD ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5102
Country	:	US
Telephone Number	:	718-531-7739
Fax Number	:

Provider Business Practice Location Address
First Line	:	1322 E 83RD ST
Second Line	:	2ND FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11236-5102
Country	:	US
Telephone Number	:	718-531-7739
Fax Number	:

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

Provider Enumeration Date	:	10/07/2008
Last Update Date	:	06/18/2015

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