Provider Demographics
NPI:1053857938
Name:MLV LLC
Entity Type:Organization
Organization Name:MLV LLC
Other - Org Name:ER LIAISON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:LEY
Authorized Official - Last Name:VERDONI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:941-237-0222
Mailing Address - Street 1:516 VENEZIA PKWY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2836
Mailing Address - Country:US
Mailing Address - Phone:941-237-0222
Mailing Address - Fax:208-330-2458
Practice Address - Street 1:516 VENEZIA PKWY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2836
Practice Address - Country:US
Practice Address - Phone:941-237-0222
Practice Address - Fax:208-330-2458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty