Provider Demographics
NPI:1164030045
Name:MITCHELL-SPRUAL, MARVA (NP-C)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:
Last Name:MITCHELL-SPRUAL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 SAGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:WENONAH
Mailing Address - State:NJ
Mailing Address - Zip Code:08090-1536
Mailing Address - Country:US
Mailing Address - Phone:856-649-3404
Mailing Address - Fax:
Practice Address - Street 1:4361 ROUTE 42
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1794
Practice Address - Country:US
Practice Address - Phone:856-885-4579
Practice Address - Fax:856-885-4582
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01047400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily