Provider Demographics
NPI:1134488984
Name:DORVIL, MARIE CLAUDE
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:CLAUDE
Last Name:DORVIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9131 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5555
Mailing Address - Country:US
Mailing Address - Phone:718-819-2830
Mailing Address - Fax:718-819-2830
Practice Address - Street 1:9131 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5555
Practice Address - Country:US
Practice Address - Phone:718-819-2830
Practice Address - Fax:718-819-2830
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-15
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22376162163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse