Provider Demographics
NPI:1134136575
Name:JAY, MARVA (LVN)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:
Last Name:JAY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 N STEMMONS FWY STE 5011
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-3832
Mailing Address - Country:US
Mailing Address - Phone:972-685-0644
Mailing Address - Fax:214-677-6954
Practice Address - Street 1:8500 N STEMMONS FWY STE 5011
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-3832
Practice Address - Country:US
Practice Address - Phone:972-685-0644
Practice Address - Fax:214-677-6954
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009923164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009923Medicare ID - Type UnspecifiedINITIAL LICENSE